Celiac

Question 1

prevalence and geographical distribution

Answer 1

• 2 million ppl have CD (.025%)
• geographic distribution: highest in northern Africa (5%) and middle east 2%
• women and whites have higher predispositions to CD

Question 2

types of CD

Answer 2

Classical: Most common type, mainly diagnosed as babies, manifests as typical symptoms of diarrhea, malabsorption, weight loss, etc.
Non-classical: Presents mostly as non-intestinal manifestations of CD like osteoporosis, vitamin deficiencies, anemia, abnormal liver function, neuropathy.
Silent/Subclinical: Patients experience no CD symptoms.
Potential: Normal small bowel structure but positive serology and presence of HLA-DQ2 or HLA-DQ8.
Refractory: CD symptoms still remain after months of strict dieting.

Question 3

HLA and Non HLA genes

Answer 3

HLA: the presence of MHC class II proteins is the biggest known genetic risk factor accounting for 35% of genetic risk
Specifically HLA-DQ2 and HLA-DQ8 genes.
Non HLA: Studies show 9 non-HLA genes that contribute to the development of CD. Many of these genes are involved in the creation of tTGA, and there is an overlap between tTGA development and CD
Two examples of these genes are CTLA4 and LPP

Question 4

pathogenesis

Answer 4

Exposure to gliadin peptide leads to autoimmune response involving T cells and B cells.
Autoantibodies target tTGA enzyme
The DQ-peptide complexes activate CD4+ T cells that produce cytokines. The cytokines are responsible for the proinflammatory circuits that are part of the immune response to gluten. The overproduction of cytokines causes toxicity that leads to epithelial cell death and villous atrophy

Question 5

previous and current treatment

Answer 5

Screenings and routine tests
Gluten-free diet
after eating gluten take Antacids, anti-diarrhea meds, pain relievers
Mineral, iron, folate, and vitamin supplements