When symptoms suggestive of celiac dis case have been present for over three months, irrespective of tests of absorptive function, a jejunal biopsy is indicated, but this should be preceded by at least a week of a gluten-containing diet.
If severe mucosal damage is found, a gluten-free diet should be prescribed for several years, and in many cases must be continued until growth has ceased.
Equivocal findings, which are most likely in the early months of the disease, call for further assessment including repeat biopsy when symptoms persist on a gluten-contain ing diet.
Baker, S.J., Ignatius Mercy, Mathan, V.I., Vaish, S.K. and Chacko, C.C.: Intestinal biopsy in tropical sprue. In Intestinal Biopsy. Ciba Foundation, London , J. A. Churchill, 1962.
3.
Booth, C.C., Stewart, J.S., Holmes, R. and Brackenbury, W.: Dissecting microscope appearance of jejunal mucosa. Ibid.
4.
Burke, V., Kerry, K.R. and Anderson, C.M.: The relationship of dietary lactose to refractory diarrhoea in infancy . Austral. Paediat. J.1: 147, 1965.
Cameron, A.H. , Astley, R., Hallowell , M., Raw. son, A.B., Miller, C.G., French, J.M. and Hubble, D.V.: Duodeno-jejuno biopsy in the investigation of children with coeliac disease. Quart. J. Med.31: 125, 1962.
7.
Creamer, B. and Pink, I.J.: Paneth cell deficiency. Lancet1: 304, 1967.
8.
Crosby, W.H. and Kugler, H.W.: Intraluminal biopsy of small intestine . Amer. J. Digest. Dis.2: 236, 1957.
9.
Fottrell, P.F. and Dolly, O.: Jejunal disaccharidases in coeliac disease . Irish J. Med. Sci. Series 7, 35, Jan. 1968.
10.
Greulich, W.W. and Pyle, S.I.: Radiographic Atlas. California, Stanford University Press, 1959.
11.
Hindle, W. and Creamer, B.: Significance of a flat small-intestinal mucosa. Brit. Med. J.2: 455, 1965.
12.
Hubble, D.: Diagnosis and management of coeliac disease in childhood. Brit. Med. J.2: 701, 1963.
13.
Kauder, E. and Bayless, T.M.: Per-oral intestinal biopsy in children; a technique. Amer. J. Dis. Child.107: 582, 1964.
14.
MacDonald, W.C., Brandborg, L.L., Flick , A.L., Trier, J.S. and Rubin, C.E.: Studies in celiac sprue, IV; the response of the whole length of the small bowel to a gluten-free diet. Gastroenterology47: 573, 1964.
15.
McNeish, A.S. : Jejunal biopsy in infants and underweight children . Arch. Dis. Child.42: 623, 1967.
16.
McNicholl, B. and Egan, B.: Jejunal biopsy in childhood. Brit. Med. J.1: 57, 1964.
17.
Messer, M. and Dahlqvist, A.: A one-step ultra-micro method for the assay of intestinal disaccharidases. Analyt. Biochem.14: 376, 1966.
18.
Rubin, C.E. and Dobbin, W.O.: Peroral biopsy of the small intestine, a review of its diagnostic usefulness. Gastroenterology49: 676, 1965.
19.
Sheldon, W. and Tempany, E.: Small intestine peroral biopsy in coeliac children. GUT7: 481,1966.
Stanfield, J.P., Hutt, M.S.R. and Tunnicliffe , R.: Intestinal biopsy in kwashiorkor. Lancet2: 519, 1965.
22.
Stewart, J.S. , Pollock, D.J., Hoffbrand , A.V., Mollin, D.L. and Booth, C.C.: A study of proximal and distal intestinal structure and absorptive function in idiopathic steatorrhoea. Quart. J. Med.36: 425, 1967.
23.
Tanner, J.M. and Whitehouse, R.H. : Institute of Child Health, and J. Collard & Sons, London, 1959.
24.
Townley, R.R.W. , Khan, K.T. and Swachmann , H.: Quantitative assay of disaccharidase activities of small intestinal mucosal biopsy specimens in infancy and childhood. Pediatrics36: 911, 1965.
25.
Townley; R.R.W. , Cass, M.H. and Anderson, C.M.: Small intestinal mucosal patterns of coeliac disease and idiopathic steatorrhoea seen in other situations. GUT5: 51, 1964.
26.
Van de Kamer, J.H., Huinink, H. ten B. and Weijers , H.A.: Rapid method for the determination of fat in feces. J. Biol. Chem.177: 347, 1949.
27.
Welsh, J.D. and Porter, M.G.: Reversible secondary disaccharidase deficiency . Amer. J. Dis. Child.113: 716,1967.
