Refer for endoscopy for biopsy

You discuss the results with Davina’s parents. You explain that the antibody tests show that she has antibody’s against gluten, which is a protein found in wheat, so is present in bread, pasta, biscuit. This finding, combined with her poor weight gain, is suggestive of coeliac disease, which is an allergic condition of the small intestine. In this condition, the lining of the intestine becomes inflamed because of the gluten in the diet. The consequence of this is that the intestine does not absorb nutrients properly.

The parents ask you what can be done about this.

You explain that, once the diagnosis is made, she will need to go on a diet without gluten. Then her gut will stop being inflamed and start absorbing properly again. The new diet will need to continue lifelong.

First, however, a biopsy is needed to establish for certain whether Davina has coeliac. It would not be appropriate to make a lifelong change to her diet without being completely sure of the cause.

Davina’s parents ask about how the biopsy is done and learn that an anaesthetic is needed. However they are happy with your explanation. She is booked in for the procedure the following week.

Two weeks later you see Davina again with her parents. This time you are in the gastroenterology clinic, and the specialist has asked you to come to join the consultation.

The procedure went well, although Davina’s parents report that she was frightened before she went to sleep.

The biopsy results are back now and show that she has villous atrophy in the duodenal and jejunal specimens that were taken. This confirms that she has coeliac disease.

Her parents had been expecting this new and are pleased that this is now clear. The gastroenterologist introduces them to the dietician and she takes them to another clinic room to go through the diet they will need to adhere to.

Some iron and vitamin supplements are also prescribed.