Prognosis in coeliac disease: A Review of Seventy-Three Cases

Information as to the prognosis in coeliac disease is not abundant.Several series of cases have been reported, but the mortality given varies considerably; there are fewer records of the fate of those children who do not die of the disease.Fifty years ago Gee (1888) wrote, 'death is a common end,' and Lehndorff and Mautner (1927) thought the prognosis was so hopeless that treatment was of little avail.Sauer (1927), however, recorded a series of twenty-five cases with one fatality.Evidence from another aspect was given by Bennett, Hunter and Vaughan (1932), who collected fifteen examples of the disease in adults, in most of whom the disorder dated from infancy.It would thus appear that though we may agree with Parsons (1932) and with Neale and others (1935) that coeliac disease responds remarkably well to treatment, yet there may be some cases that can run a protracted course.Such patients are not ill enough for their disorder to be recognized until adult age is reached, when, with the skeleton drained of calcium and crippled beyond repair, the disease declares itself.Facts in favour of this view will be given in this paper.In the present investigation an attempt was made to learn the after-history of seventy-three cases of coeliac disease which had been in the Hospital for Sick Children, Great Ormond Street, London, between the years 1923 and 1938.The diagnosis of coeliac disease was made on the history of diarrhoea, anorexia and loss of weight, accompanied by the classical clinical features, and with the finding of an excess of normally split fat in the stools on more than one occasion.Only those patients have been included who were under observation long enough for an illness due to a transient digestive upset to be excluded.Fifteen years have elapsed since the first patient was in the Hospital, and the oldest living subject is now sixteen-and-a-half years old.Twenty-two died in Hospital, and all but ten (fourteen per cent.) of the remainder have been