Celiac Disease

Question 1

AKA

Answer 1

gluten sensitive enteropathy

Question 2

Pathogenesis

Common alleles

Pop

Serum antibodies

Answer 2

immunologic response to gliadin (gluten, wheat, barley, rye)

HLAD-DQ2, DQ8

European

anti-glaidin, anti-endomysial, anti-TTG

Question 3

TTG

this results in

most common areas of involvement

Answer 3

crosslinks gluten proteins, deaminates glutamine residues- triggers a t cell response

blocked epithelial cell differentiation, SI villous atrophy

duodenum and proximal jejunum

Question 4

CM onset

Above 10

at risk for

Answer 4

childhood (6-24 mnths)

chronic diarrhea, steatorrhea, flatulence, failure to thrive, severe anemia and osteopenia

minor complaints, malabsorption
IM diarrhea/cons, fatigue, Fe def, anemia

severe anemia (Fe, folate, VB12 def) and osteopenia (VD/Ca def)

Question 5

Dz associated w celiac

Autoimmune

Immunodef

Derm

Gastro

Answer 5

Addison, Graves, T1DM, MG, vitiligo

IgA def

Dermatitis Herpetiformis

EoE, GERD, IBS

Question 6

Malignancy

Neuro disorders

Psychiatric do

Answer 6

Lymphoma, leukemia, GI canc

Migraine, Epilepsy, myopathy

Depression, anx

Question 7

Dx

sensitive/spec test for celiac

Consdidered neg if

IgA def and neg TTG IgA

Answer 7

Serologic testing and SB biopsy

TTG IgA antibody

normal total IgA and neg TTG IgA

get TTG IgG checked

Question 8

with clinical suspicion, get

Duodenal biopsy

Inc

Answer 8

upper endoscopy w SB biopsy

flat, total atrophy, loss of villi, crypt hyperplasia

Intraepithelial CD8 t cells, plasma/mast/ cells, eosinophils

Question 9

Histo findings

testing performed when pts

Answer 9

non specific

consume gluten rich diet

Question 10

Mx

screen for

Answer 10

gluten avoidance, remeasure IgA after 6-12 mnths

nutritional def
supplementation

Question 11

Prognosis

gluten free diet

Answer 11

excellent w diet- benefit over weeks/months

reduces risk of lymphoma/GI cancer in pts w untreated celiac disease