Celiac Disease Flashcards
Celiac disease is also called what?
Gluten sensitivity or enteropathy
What is celiac disease?
Malabsorption disorder caused my immunologic response to gluten
Gluten is a storage protein found in what?
Wheat, barley, rye
The problem with celiac disease is with what component of gluten?
Gliadin
What kind of damage occurs with celiac disease?
Diffuse damage to proximal SI mucosa and villous atrophy
Has the incidence of celiac disease increased or decreased in the last 50 years?
Increased
Largest affected population with celiac disease?
Whites of Northern European ancestry but also present in worldwide populations
Etiologies of celiac disease?
Genetics, environmental gluten, overexposure, incidence in 1st degree relatives: 10%
What is steatorrhea?
Fat in the stool
How long does it take to diagnose celiac disease?
Delayed dx, s/s present usually 10 yes before dx
How fast is the dx of celiac disease in infancy if failure to thrive?
Usually rapid testing/dx
Signs and symptoms occur at what age for celiac disease?
Any age, infancy through 8th decade of life (10-40 y/o MC**)
How many patients are asymptomatic at initial finding of celiac disease?
40%
(Starting to see a shift toward asymptomatic pts)
Classic symptoms of celiac disease?
Diarrhea, steatorrhea, weight loss, weakness, abdominal distention, glossitis
In children: failure to thrive, stunted growth, delayed puberty
Atypical symptoms of celiac disease?
Fatigue, depression, delayed puberty, amenorrhea, infertility, peripheral neuropathy
Celiac disease symptoms may be related to which specific nutrient deficiencies ?
Iron, Vit K, Vit A, Vit B12
Iron deficiency signs w celiac?
Fatigue, pallor (look for pallor inside of mouth as well)
Vit K deficiency symptoms in celiac?
Easy bruising
Vit A deficiency symptoms in celiac?
Hyperkeratosis, skin abnormally thickened on palms and soles
Vit B12 deficiency in celiac?
Peripheral neuropathy
Celiac disease may coincide w what?
Lactose intolerance
Physical exam is usually normal for celiac unless there is a finding related to what ?
Nutrient deficiency
What is dermatitis herpetiformis?
Cutaneous variant of celiac disease: pruritic raised papulovesicles over extensors of extremities, trunk, scalp, neck (very itchy!!) w little to no GI symptoms
Small intestine biopsy will show what with dermatitis herpetiformis?
Histology correlated w celiac
How many patients w celiac have DH?
Few
Treatment of HD?
Dapsone- anti inflammatory, also alleviate itching to avoid infection
Will DH lesions respond to a GF diet?
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
Ddx for celiac disease?
IBS, eosinophilic gastroenteritis, bacterial overgrowth (surg complication, slower gut transit,obstruction), lactose intolerance, IBD
Gold standard for evaluation of celiac disease?
Small intestinal biopsy: taken from proximal & distal duodenum
Histopathology of SI biopsy shows what for celiac?
Partial to complete villous atrophy and intraepithelial lymphocytes
What does celiac serology check for?
Antibodies IgA endomysial and IgA tissue transglutaminase 
What is the sensitivity and specificity of celiac serology?
Both blood tests have a greater than 90% sensitivity and greater than 95% specificity
What should you consider about serology testing for somebody following a gluten-free diet?
If someone is gluten-free on their own, already at can skew the results
Which serology test is usually the initial test and which test is used to confirm results?
TTG usually initial test and endomysial to confirm
Lab test for celiac disease may have abnormal value is related to what?
Specific nutrient deficiency such as anemias, low vitamin levels, and low calcium
What is the treatment for celiac disease?
Lifelong strict, elimination of gluten from diet, correct, nutritional deficiencies, support groups
When will symptom improvement be evident after switching to a gluten-free diet?
Within a few weeks
When will antibody levels become undetectable and somebody with celiac disease?
Undetectable after 3 to 12 months on gluten free diet
What kind of referral should you give somebody with celiac disease?
Dietitian
What’s important to remind patients about food, especially processed food when on a gluten-free diet?
Food may be cross contaminated 
Which grains are safe for someone with celiac disease?
Rice, corn, potatoes, buckwheat, soybean, tapioca flours safe
Caution w oats
Why are support groups beneficial for those with celiac disease?
There is usually an increase in anxiety and depression in a newly diagnosed patient
What are associations and complications of celiac disease?
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
What is the prognosis for celiac disease?
Excellent with proper diagnosis, treatment, strict diet, adherence
What is a non-celiac gluten sensitivity?
A symptomatic response to gluten ingestion with no serologic or histologic changes
What kind of symptoms does non-celiac gluten sensitivity have?
Similar symptoms to celiac disease: abdominal pain, bloating, change in bowel patterns
How fast are the onset of symptoms for non-celiac gluten sensitivity?
Hours to days after ingestion
