Celiac Disease

Question 1

What are the 2 major genes involved in CD?

Answer 1

HLA-DQ2 and HLA-DQ8

Question 2

What are the risk factors for CD?

Answer 2

Dermatitis herpetiformis: 100%
First degree relative with celiac disease: 5-22%
Autoimmune thyroid disease: 1.5-14%
Down syndrome: 5-12%
Turner's syndrome: 2-10%
T1DM children: 3-8%
T1DM: 2-5%

Question 3

Which grains contain gluten?

Answer 3

wheat, rye, malt, barley

Question 4

What is the molecule/protein of gluten that causes the intolerance?

Answer 4

alpha-gliadin

Question 5

What are the 3 theories of environmental triggers of CD?

Answer 5

• young age of introduction
• short or no breastfeeding
• viral infections in infancy

Question 6

What are the classic and atypical clinical manifestations of CD?

Answer 6

Classic: diarrhea, abdominal pain, cramping, bloating, gas
Atypical: bone and joint pain, muscle cramping, fatigue, peripheral neuropathy, seizures, skin rash, mouth ulcerations

Question 7

What are the common and uncommon signs and symptoms of CD?

Answer 7

Common:
diarrhea, fatigue, abdominal pain, borborygmus (gurgling noise made in intestines), weight loss, abdominal distention, flatulence

uncommon:
osteopenia/osteoporosis, abnormal liver function, vomiting, iron-deficiency anemia, neurologic dysfunction, constipation, nausea

Question 8

What are the 3 diagnosis/treatment?

Answer 8

1. physical exam and blood testing
2. duodenal biopsy
3. implement GFD

Question 9

What are the comorbidities of CD?

Answer 9

• osteoporosis
• thyroid dysfunction
• deficiencies in folic acid, vitamin B12, fat-soluble vitamins, iron
• increased mortality due to increased risk of malignancy

Question 10

What are the 4 stages of clinical presentation?

Answer 10

CLASSICAL
diarrhea
gas/bloating
weight loss

ATYPICAL
constipation
dyspepsia
osteoporosis
rash
neuropathy
hepatitis
infertility
dental enamel hypoplasia

SILENT
no signs and symptoms
positive Ab
abnormal biopsy

LATENT
no signs and symptoms
positive Ab
normal biopsy (in remission)

Question 11

What is the recommended single serologic test for CD screening?

Answer 11

the tTG antibody test

Question 12

What does the GFD include?

Answer 12

the equivalent of 2 servings of gluten containing foods per day for up to 8 weeks
for 14-28d: 3-7.5g gluten per day

Question 13

What is the key to managing CD?

Answer 13

C: consultation with a skilled RD
E: education about the disease
L: lifelong adherence to GFD
I: identification and treatment of nutritional deficiencies
A: access to an advocacy group
C: continuous long-term follow-up

Question 14

What is the amount of oats that should be limited for adults and children?

Answer 14

Adults: 50-70 g/d
Children: 20-25 g/d

Question 15

What are the nutrient issues with CD?

Answer 15

body weight (usually weight gain with GFD)
micronutrient deficiencies:
-folate
- ferritin
- vit D
- vit A
- vit B12
- fiber