Celiac Disease

Question 1

Simple definition of celiac disease

Answer 1

Autoimmune disease triggered by dietary gluten resulting in inflammation in the small intestine

Question 2

Detailed definition of celiac disease

Answer 2

Systemic autoimmune disease triggered by the gluten byproduct gliadin in the small intestine (mostly the duodenum) leading to inflammation and cell death

Question 3

Pathophys of celiac

Answer 3

1. ingest gluten
2. gluten gets digested in stomach and gluten byproduct gliadin is produced
3. gliadin moves into small intestine
4. gliadin binds to secretory IgA and moved into the lamina propria
5. gliadin is processed by tissue transglutaminase (tTG)
6. immune response follows
7. inflammatory mediators (cytokines, T cells) are released; anti-gliadin, anti-tTG, and anti-endomysial antibodies (EMA) are released
8. destruction of villi and enlarging of the crypts

result in s/s ➔ malabsorption, diarrhea, bloating, failure to thrive
result in dermatitis herpetiformis ➔ anti-tTG reacts with tTG found in epidermis

Question 4

Risk factors for celiac

Answer 4

other autoimmune diseases
genetics
caucasian
gastroenteritis in childhood
family history of celiac
obesity

Question 5

s/s of celiac

Answer 5

overall nonspecific
adults: diarrhea, bloating
children: failure to thrive
Other GI s/s: constipation, fatty stools (steatorrhea)

extraintestinal s/s: dermatitis herpetiformis, malabsorption (anemias, mouth ulcers, osteoporosis, coagulopathies), chronic kidney disease, delayed menarche, neuro s/s (seizures, headaches, weakness)

Question 6

Definitive ix for celiac

Answer 6

duodenal biopsy ➔ atrophied villi and enlarged crypts

Question 7

screening ix for celiac

Answer 7

must be eating gluten
blood work:
- anti-tTG (IgA) - higher SNOUT
- anti-EMA (IgA) - higher SPIN

check levels of IgA, pt may just have lower levels of IgA as a whole so then they wouldn’t have great anti-tTG and anti-EMA results

Question 8

Other Ix to consider for celiac w/up

Answer 8

bloodwork
- CBC - anemias, pancytopenias, infection
- calcium - osteoporosis
- electrolytes - potassium, sodium, chloride, bicarb
- glucose - diabetes work up
- TSH - thyroid work up
- PT/INT, aPPT - coagulation
- genetic HLA testing + underlying genetic disorders

Imaging
- upper endoscopy - visualize the duodenum

Question 9

Tx for celiac

Answer 9

gluten avoidance
refer to nutrition or gastroenterologist
limited evidence for use of corticosteroids in celiac crisis

Question 10

ddx for celiac

Answer 10

peptic ulcer disease - bc stomach pains after meals
crohn’s disease - bc inflammation may be in the small intestine
gastroenteritis

Question 11

cx of celiac

Answer 11

• increased risk of small bowel cancer
• children: poor growth and development bc malabsorption
• obstetric complications in untreated celiac

Question 12

epidemiology of celiac

Answer 12

can develop in childhood or adulthood - peak presentation is in childhood
more common in Caucasians
0.5-1% of the general population - COMMON DISEASE
more common in women
more common in ppl with other autoimmune diseases (T1DM) or FH of celiac