Celiac Disease

Question 1

Celiac disease

Answer 1

Immune mediated systemic disorder elicited by ingestion of gluten in genetically susceptible individuals.
Gluten-dependent intestinal inflammation with villous atrophy leading to various clinical manifestations. CeD specific antibodies. Specific genetic asset

Question 2

Celiac Disease Sxs

Answer 2

Diarrhea
Vomiting
FTT/weight loss
Abdominal pain/bloating
Constipation

Question 3

Celiac disease: extra intestinal manifestations

Answer 3

• Dermatitis Herpetiformis
• Malnutrition related: short stature, delayed puberty, anemia resistant to oral iron
• Liver and biliary disease: autoimmune liver disease, benign hypertranaminasemia
• Osteopenia
• Arthritis/Arthralgia
• Neuro: headache, seizures with occipital calcifications
• Behavioral changes and psychiatric disorders

Question 4

Increased Risk, should screen even if no symptoms

Answer 4

Type 1 DM
Autoimmune thyroid disease
T21
Turner
Williams
Selective IgA deficiency
Autoimmune liver disease
First degree relatives with Celiac

Question 5

test for celiac disease at any age as long as gluten as been in the diet for a few months

Answer 5

Younger than 2 years: TTG IgA, total IgA, AND Deamidated GLiadin peptides IgG.
Older than 2 years: TTG IgA and total IgA. Use TTG IgG if total IgA is <20.
If serology is negative: celiac disease is ruled out. If serology

Question 6

Celiac serologies

Answer 6

PPV:
EMA: 100%,
TTG IgA: 80%
DGP: IgG: 90%

Question 7

Celiac serology pitfalls

Answer 7

False positive TTG IgA:
-Crohn’s
-Primary biliary cirrhosis
-Type 1 DM
-Liver disorders
-Viral infections
-Cancer

Question 8

IgA Deficiency more common in celiac disease

Answer 8

Use TTG/DGP-IgG for screening and surveillance
Partial IgA deficiency can still use IgA (minimum level of serum IgA: 20).

Question 9

Biopsy rules

Answer 9

At least 4 biopsies, make sure to also take biopsies of duodenal bulb.

Question 10

DDX of increase IELs

Answer 10

• NSAIDS
• H pylori
• Peptic injury
• Viral gastroenteritis
• Crohn’s

Question 11

DDX of villous blunting

Answer 11

• Infection
• Tropical Sprue
• Peptic injury
• Viral gastroenteritis
• Crohn’s disease
• Medications (olmesartan)

Question 12

Genetic testing for celiac disease

Answer 12

HLA DQ2/HLA DQ8. If present, patient MAY have celiac disease, but very high false positive rate. If negative, can basically rule out celiac disease.

Question 13

Symptom improvement

Answer 13

GI symptoms rapidly improve, after 2 hours almost no patients have persistent symptosm.
extra intestinal symptoms also rapidly improve (can take 2 years to fully resolve).