Diagnosis of celiac disease in a patient with fecal incontinence

Background: A 69-year-old white woman presented to our gastroenterology department with loose stools, daily fecal incontinence and weight loss. She had a 3-year history of fecal incontinence, which had increased in frequency and severity in the year before her most recent presentation. Prior diagnostic workup included anorectal manometry, revealing global sphincter dysfunction, which improved slightly with biofeedback therapy, and colonoscopy, which proved unremarkable. At the time of referral, the patient was taking loperamide 2mg once daily. Investigations: Physical examination, fecal fat stain, abdominal CT scan, therapeutic trial of pancreatic enzymes, celiac disease serologic tests, and upper endoscopy with small-bowel biopsy. Diagnosis: Celiac disease. Management: Gluten-free diet.