Celiac Disease Flashcards
Define celiac disease
Autoimmune disease. Ingestion of gluten triggers a T-cell mediated response that damages intestinal villi.
Which regions of the intestine are mostly affected by celiac disease?
Distal duodenum
Proximal jejunum
Explain the pathogenesis of celiac disease.
Gluten is broken down into metabolites including GLIADIN. Deaminated gliadin interacts with antigen-presenting cells to produce a T-cell mediated response.
Sources of gluten (BROW)
Barley, rye, oat, wheat
What alleles are highly associated with celiac disease?
HLA DQ2 and DQ8
3 ways with which you can diagnose celiac
IgA EMA
IgA TTG
Biopsy
Gold standard test for celiac
IgA EMA (but expensive so less commonly used; also becomes negative with a GF diet)
First line test for celiac
IgA TTG (cheap, widely available, sensitive)
TTG is found in everyone, but is elevated in celiac disease.
Levels of TTG decrease with GF diet.
IgA TTG can yield false positives for…
patients with other autoimmune conditions (DM type I, liver disease)
What can you do if the celiac patient is IgA deficient?
Perform serology for IgG instead
Pathological signs of celiac on biopsy (3)
Atrophied villi
Mucosal inflammation
Crypt hyperplasia
6 complications of celiac disease
- Anemia
- Bone disease
- VB12/folate deficiency
- Increased risk of malignancy
- Neuropsychiatric disease
- Kidney disease
Clinical presentation/symptoms
- Steatorrhea
- Nocturnal diarrhea
- Abdominal discomfort, bloating
- Fatigue
- Weight loss
- Dermatitis herpetiformis rash
How can we test compliance to a GF diet in a celiac patient?
IgA TTG test (TTG levels should fall back to normal over 6 months)
Atypical celiac sprue
Minor GI symptoms
Anemia, osteoporosis, arthritis, infertility, neurological disorders
Asymptomatic (silent) celiac sprue
Asymptomatic
Latent (potential) celiac sprue
Normal villi, but positive serology for celiac disease markers
Refractory celiac disease
Does not improve with GF diet
