13b Gluten sensitivity disorders

Question 0

Celiac disease

Answer 0

1 in 100 northern european descent
1 in 10 for 1st degree relatives
70-80% monozygotic twins
Screening 1st degree relative

Question 1

Atypical sprue

Answer 1

IronD
Osteoporosis- Most common non-GI presentation (70% untreated CD, 30% Silent CD) New diagnosed need a bone density
Dermatitis herpataformis - (pruritic papulovesicular rash on extensor surfaces)
IBS
DM type I
Elevated LFTs

Question 2

CD deficicencies

Answer 2

Iron, Calcium, Mg, ADEK

Folate/b12 D

Question 3

Associations with CD

Answer 3

Trisomy 21, Turners
DM I ,Thyroid, addisons, PBC, sjogrens, autoimmune hepatitis
Selective IgA deficiency

Question 4

Celiac neurologic symptoms

Answer 4

Ataxia (B12)
Night blindness (Vitamin A) 
Seizures
HA
Epilepsy
Mood disturbances
Peripheral neuropathies

Question 5

CD Gynecologic and fertility problems

Answer 5

Amenorrhea 1/3 untreated CD
Infertility common
Spontaneous abortion
Intrauterine growth retardation
Male infertility

Question 6

Path

Answer 6

Gliaden molecule from gluten amidated in cell

Presented on HLA DQ2 or 8 (95% DQ2 homozygous, rest D28 heterozgous [negative can basically rule out CD])

Question 7

CD diagnosis

Answer 7

IgA and IgG of deamidated dliadin
IgA tissue Transglutaminase
IgA Endomysial antibody

Small intestine biopsy shows scalloping or notching with villous atrophy, Villous blending crypt hyperplasia, and intraepithelial lymphocytosis

Question 8

Diagnosis pitfalls

Answer 8

Labs
*Antibodies not constant- decrease with GF diet
*IgA deficient may give false negatve - test IgG and biopsy
Endoscopy:
*enough biopsies- can be patchy
*GFdiet will return to normal
*Villous atrophy could be NSAIDS infection or IBD

Question 9

CD treatment

Answer 9

GFdiet
No Malt
Watch for gluten in meds

Question 10

CD prognosis

Answer 10

Associated with CV disease and Malignancy

• Enteropathy associated TCL - rare but 10% 5 yr survival
• risk normalizes with GFD

Question 11

Wheat allergy

Answer 11

Bakers asthma
Rhinits
Contact urticaria
Wheat dependent exercise induced anaphylaxis

Question 12

Non Celiac gluten sensitivity

Answer 12

Feel better on GFD but no evidence of CD

Perhaps fermentable saccharides to blame (low FODMAP diet)

Question 13

If GFD

Answer 13

Suggest multivitamin
Watch for fiber needs
Be aware of costs- Its$$$

Question 14

Environmental Enteropathy (formerly tropical sprue)

Answer 14

Stunted growth and diarrhea in developing countries
>150 million children worldwide
malnutrition contributes to disorder
reversable with proper nutrition

Repeated diarrhea in first 3 yrs of life, histology similar to severe CD