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Even though children with celiac disease may appear to be progressing satisfactorily while taking gluten-free diets, dietary lapses and persisting mucosal abnormalities are common. Of 32 children with celiac disease proven by biopsy only ten kept regularly to their diet, and 11 continued to ingest gluten regularly. Despite satisfactory clinical progress, intestinal biopsy specimens obtained after at least one year of a gluten-free diet were markedly abnormal in eight and were normal in only 14 children. Laboratory criteria also failed to detect those with persisting mucosal abnormalities. The only way to ensure that the small-bowel mucosa returns to normal and remains so is by intestinal biopsy.

SUMMARY A prospective study is described comparing microscopy of random faecal specimens for the presence of neutral and split fat by a relatively simple, cheap, and rapid method with standard chemical estimation of faecal fat. The method of microscopy was found to be reliable in excluding steatorrhoea in children over the age of 3 months.Quantitative biochemical estimation of faecal fat content is an accepted routine procedure for investigation of malabsorption. The standard technique is to collect all samples of faeces passed during a three-or five-day period and to estimate the fat contenit in the sample. This method is liable to show false negative results due to incomplete collection (Ditchburn et al., 1971) or to irregular bowel action. Stool markers have been used to improve the situation but still the method is time-consuming and needs close supervision, particularly in children.

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