Celiac Disease

Question 1

What is celiac disease

Answer 1

• autoimmune disorder that occurs in genetically predisposed people of all ages from middle infancy onward
• gluten-sensitive enteropathy, (protein in wheat, rye, barley)

Question 2

What dose Celiac disease lead to?

Answer 2

Celiac disease leads to a truncating of the villi lining the small intestine (called villous atrophy) and secondary
to the malabsorption syndrome

Question 3

Celiac disease - essential factors:

Answer 3

3 essential factors of CD:

1. Gluten
2. Genetic susceptibility
3. Mysterious trigger

Question 4

Celiac disease - Clinical features:

Answer 4

• Distention and bloating of the stomach
• Loose and greasy stool (steatorrhea)
• Weight loss or failure to gain weight
• Growth failure
• Depression, irritability
• Loss of fat tissue

Question 5

Table on

Answer 5

page 221

Question 6

Celiac disease - Diagnostics:

Answer 6

• Antibody testing
• Small bowel biopsy
• Patho - mechanism - genotype

Question 7

Celiac disease - Diagnostics: Patho - mechanism - genotype:

Answer 7

• HLA DQ2 in 95% celiac patients
• HLA DQ8 in 5% of celiac patients other family members
• HLA DQ2 / DQ8 in 30-40% of general population
  
  • High impact of negative predictive
    ^Negative score- DQ2/DQ8 excludes celiac diagnose in 99%

Question 8

Celiac disease - Diagnostics: Small bowel biopsy:

Answer 8

Marsh Staging
1 - increased number of intraepithelial lymphocytes, usually exceeding 20 per 100 enterocytes
2 - proliferation of the crypts of Lieberkuhn
3 - partial or complete villous atrophy

Question 9

Food allergy diagnosis:

Answer 9

• Patient history
• Food challenge
  ○ open
  ○ blind
  ○ double blind
• Skin tests
• Total & specific IgE

Question 10

Celiac disease - Treatment

Answer 10

• gluten- free diet
  ○ allowed: corn, rise, buckwheat, millet, potato flour, oats
• no gluten for the lifelong (lymphoma prophylaxis)
• additionally milk and lactose free at the beginning (4-6 weeks)
• Manage micronutrient deficiencies (Fe, B1, B6, folate, B12, Zinc)


Question 11

Celiac disease - Differentials:

Answer 11

• Tropical sprue

- Whipple disease


Question 12

Celica disease - Complications

Answer 12

• clinical features of malabsorption
• Secondary lactase deficiency
• Adenocarcinoma of the small bowel
• Infertility - potentially in untreated/diagnosed disease
• Osteopenia/ osteoporosis- potentially in untreated/diagnosed disease


Question 13

Celica disease - Prognosis:

Answer 13

Therapy response
○ Clinical remission: Immediate
○ Serologic response: Weeks-months
○ Mucosal healing: 6-24 months