Mechanisms of diarrhoea and malabsorption in gluten-sensitive enteropathy : Pathology of diarrhoeal disease

The potential for diarrhoea in gluten-sensitivity depends on the destructive element to proximal surface epithelium leading to an increased distal osmotic load, the secretory state of the mucosa generated by cell-mediated inflammation within lamina propria and other ancillary factors such as reduced motility, achlorhydria, bacterial overgrowth, reduced mucosal release of secretin and cholecystokinin, and reversible/irreversible defects in pancreatic function. Whether diarrhoea actually occurs will depend on the extent of the lesion and hence the length of residual ileum which, together with proximal colon, can provide additional functional (absorptive) capacity and thus an important diarrhoea-sparing effect