Celiac (ACG 2023)

Question 1

If patient refuses/unable to do EGD, what 2 serological markers positive for diagnosis of CD

Answer 1

-high level TTG IgA ( > 10x ULM normal)
-positive endomysial antibody (EMA)

Question 2

If IgA deficiency, then can test either (2)

Answer 2

-deaminated gliadin peptide (DGP)
-TTG

Both are IgG serology

Question 3

If already on gluten free diet, can test with:

Answer 3

HLA DQ2/DQ/8

Question 4

Marsh classification Type 1

Answer 4

-normal villi
-normal crypts
- IEL/100 EC: > 40

Question 5

Fu biopsy for assessment of mucosal healing if asymptomatic after ** years of starting GFD should be considered

Answer 5

2 years
(Although 1 US study showed median time from the onset of GFD to achieve mucosal healing in adults was 3 years)

Question 6

Refractory CD 2 types
-ongoing symptoms and/or signs of malabsorption with intestinal colloid atrophy despite GFD for at least 12 months

Answer 6

1: polyclonal T cell population (likely has heterogenous group of etiologies, including inadvertent gluten exposure)

2: clonal t-cell population
-poorer prognosis
-precursor to enteropathy associated t-cell lymphoma

Question 7

Which vaccine recommended for CD patients

Answer 7

Pneumococcal vaccine
(The increased risk thought to be 2/2 hyposplenism which is often subclinical)

Question 8

How does CD cause malaborpstion

Answer 8

-Injury to small intestine with loss of absorptive surface area, reduction of digestive enzymes, and consequential impaired absorption of micronutrients (fat soluble vitamins, iron, b12, folic acid)
-inflammation causes net secretion of fluid that results in diarrhea
-weight loss: due to failure of absorption of adequate calories
-abdominal pain/bloating: due to maldigestion

Question 9

Marsh type 2

Answer 9

-normal villi
-hyperplasia crypts
- IEL/100 EC: > 40

Question 10

Marsh type 3

Answer 10

-atrophy villi (mild, moderate, severe)
-hyperplastic crypts
- IEL/100 EC: > 40