Celiac Disease

Question 1

Celiac disease is also called what?

Answer 1

Gluten sensitivity or enteropathy

Question 2

What is celiac disease?

Answer 2

Malabsorption disorder caused my immunologic response to gluten

Question 3

Gluten is a storage protein found in what?

Answer 3

Wheat, barley, rye

Question 4

The problem with celiac disease is with what component of gluten?

Answer 4

Gliadin

Question 5

What kind of damage occurs with celiac disease?

Answer 5

Diffuse damage to proximal SI mucosa and villous atrophy

Question 6

Has the incidence of celiac disease increased or decreased in the last 50 years?

Answer 6

Increased

Question 7

Largest affected population with celiac disease?

Answer 7

Whites of Northern European ancestry but also present in worldwide populations

Question 8

Etiologies of celiac disease?

Answer 8

Genetics, environmental gluten, overexposure, incidence in 1st degree relatives: 10%

Question 9

What is steatorrhea?

Answer 9

Fat in the stool

Question 10

How long does it take to diagnose celiac disease?

Answer 10

Delayed dx, s/s present usually 10 yes before dx

Question 11

How fast is the dx of celiac disease in infancy if failure to thrive?

Answer 11

Usually rapid testing/dx

Question 12

Signs and symptoms occur at what age for celiac disease?

Answer 12

Any age, infancy through 8th decade of life (10-40 y/o MC**)

Question 13

How many patients are asymptomatic at initial finding of celiac disease?

Answer 13

40%
(Starting to see a shift toward asymptomatic pts)

Question 14

Classic symptoms of celiac disease?

Answer 14

Diarrhea, steatorrhea, weight loss, weakness, abdominal distention, glossitis
In children: failure to thrive, stunted growth, delayed puberty

Question 15

Atypical symptoms of celiac disease?

Answer 15

Fatigue, depression, delayed puberty, amenorrhea, infertility, peripheral neuropathy

Question 16

Celiac disease symptoms may be related to which specific nutrient deficiencies ?

Answer 16

Iron, Vit K, Vit A, Vit B12

Question 17

Iron deficiency signs w celiac?

Answer 17

Fatigue, pallor (look for pallor inside of mouth as well)

Question 18

Vit K deficiency symptoms in celiac?

Answer 18

Easy bruising

Question 19

Vit A deficiency symptoms in celiac?

Answer 19

Hyperkeratosis, skin abnormally thickened on palms and soles

Question 20

Vit B12 deficiency in celiac?

Answer 20

Peripheral neuropathy

Question 21

Celiac disease may coincide w what?

Answer 21

Lactose intolerance

Question 22

Physical exam is usually normal for celiac unless there is a finding related to what ?

Answer 22

Nutrient deficiency

Question 23

What is dermatitis herpetiformis?

Answer 23

Cutaneous variant of celiac disease: pruritic raised papulovesicles over extensors of extremities, trunk, scalp, neck (very itchy!!) w little to no GI symptoms

Question 24

Small intestine biopsy will show what with dermatitis herpetiformis?

Answer 24

Histology correlated w celiac

Question 25

How many patients w celiac have DH?

Answer 25

Few

Question 26

Treatment of HD?

Answer 26

Dapsone- anti inflammatory, also alleviate itching to avoid infection

Question 27

Will DH lesions respond to a GF diet?

Answer 27

Yes but response is slow, attempt to start GF diet and dapsone simultaneously and wean off dapsone to hopefully control w only diet once responding

Question 28

Ddx for celiac disease?

Answer 28

IBS, eosinophilic gastroenteritis, bacterial overgrowth (surg complication, slower gut transit,obstruction), lactose intolerance, IBD

Question 29

Gold standard for evaluation of celiac disease?

Answer 29

Small intestinal biopsy: taken from proximal & distal duodenum

Question 30

Histopathology of SI biopsy shows what for celiac?

Answer 30

Partial to complete villous atrophy and intraepithelial lymphocytes

Question 31

What does celiac serology check for?

Answer 31

Antibodies IgA endomysial and IgA tissue transglutaminase 

Question 32

What is the sensitivity and specificity of celiac serology?

Answer 32

Both blood tests have a greater than 90% sensitivity and greater than 95% specificity

Question 33

What should you consider about serology testing for somebody following a gluten-free diet?

Answer 33

If someone is gluten-free on their own, already at can skew the results

Question 34

Which serology test is usually the initial test and which test is used to confirm results?

Answer 34

TTG usually initial test and endomysial to confirm

Question 35

Lab test for celiac disease may have abnormal value is related to what?

Answer 35

Specific nutrient deficiency such as anemias, low vitamin levels, and low calcium

Question 36

What is the treatment for celiac disease?

Answer 36

Lifelong strict, elimination of gluten from diet, correct, nutritional deficiencies, support groups

Question 37

When will symptom improvement be evident after switching to a gluten-free diet?

Answer 37

Within a few weeks

Question 38

When will antibody levels become undetectable and somebody with celiac disease?

Answer 38

Undetectable after 3 to 12 months on gluten free diet

Question 39

What kind of referral should you give somebody with celiac disease?

Answer 39

Dietitian

Question 40

What’s important to remind patients about food, especially processed food when on a gluten-free diet?

Answer 40

Food may be cross contaminated 

Question 41

Which grains are safe for someone with celiac disease?

Answer 41

Rice, corn, potatoes, buckwheat, soybean, tapioca flours safe Caution w oats

Question 42

Why are support groups beneficial for those with celiac disease?

Answer 42

There is usually an increase in anxiety and depression in a newly diagnosed patient

Question 43

What are associations and complications of celiac disease?

Answer 43

Increased incidence of G.I. and non-G.I. cancer and intestinal lymphoma, development of intestinal ulceration, association with type one diabetes, down syndrome, turner syndrome, other autoimmune diseases

Question 44

What is the prognosis for celiac disease?

Answer 44

Excellent with proper diagnosis, treatment, strict diet, adherence

Question 45

What is a non-celiac gluten sensitivity?

Answer 45

A symptomatic response to gluten ingestion with no serologic or histologic changes

Question 46

What kind of symptoms does non-celiac gluten sensitivity have?

Answer 46

Similar symptoms to celiac disease: abdominal pain, bloating, change in bowel patterns

Question 47

How fast are the onset of symptoms for non-celiac gluten sensitivity?

Answer 47

Hours to days after ingestion