celiac disease

Question 1

Pathogenesis of celiac disease

Answer 1

Gluten is a protein found in Wheat, barley, rye, Oats (sometimes)

Gluten is broken into gliadin, taken up by tissue transglutaminase (tTG)–> deamidated gliadin

Deaminated gliadin is taken up by APCs and presented to T cells make IFN y, T cells recruit B cells/plasma cells to make Anti-gliadin Anti endomysium (Anti tTG)

Question 2

Serology of Celiac disea

Answer 2

Best test- IgA tissue transglutaminase, IgA Endomysial antibody (EMA), IgA and IgG Deamidated Gliading Antibodies

Anti Gliadin Antibodies that doent help- IGA level

Question 3

Following positive serology–>

Answer 3

Endoscopy, Scalloping/ Notching of small bowl folds

Villous blunting/ atrophy

Small intestine biopsy- multiple biopsies should be obtained (6-8_ in the 2nd and 3rd portions of the duodenum

Gluten challenge- historically required for diagnosis, currently of little value, reserved for pts with self imposed GFD

Question 4

Serologic tests (pit falls)

Answer 4

False negatives for 2 reasons: Ab levels fall on a gluten free diet: within days in very mild disease, usually takes 6-8 weeks, as long as a year in severe disease

Celiac patient that is IGA deficient, make IGA tTG and EMA, falsely negative, IGG Abs useful in situation, IgG deaminated GLiadin antibody best
Intestinal biopsy despite antibodies

Question 5

Lab abnormalities of celiac disease

Answer 5

unexplained iron deficiency anemia, reduced serum albumin, folate and b12 def, elevated LFTs

Most powerful test- IgA endo mysial antibody, IgA Tissue transglutaminase!!!!!!!!!tTG!!!!!!!!, iga and Igg deamidated gliadin antibodies

anti gliadin antibodies is non specific

Question 6

osteopenia and osteoporosis

Answer 6

Most common non GI presentation of CD
Osteo penia- untreated CD
Osteoporosis-

give a bone density scan

Question 7

Non Gi presentation of celiac disease

Answer 7

type 1 DM, thyroid dysfunction, addisons, primary biliary cholangitis, IBD , autoimmune hepatitis

Downs and turner syndrome

IgA deficiency

Dermatitis herpetiformis- very pruritic disease

Gluten free diet

Neurologic symptoms
Gynocologic-

Question 8

serologic pitfalls

Answer 8

False negatives for 2 reasons,
Ab levels fall on a gluten free diet, within days in very mild disease, usually takes 6-8 eks, as long as a year in severe disease

Celiac pts that is IGA deficient makes iga tTg and EMA falsely negative, Igg abs is useful, iGG deamidated dliadin Ab, intestinal biopsy

Question 9

Pathology pit fallss

Answer 9

villous atrophy may be patchy (sometimes not all the biposy is taken)
Patient was on a GFD, can normalize, not all villous atrophy is celiac- NSAIDS, infections, crohns disease

Question 10

Genetics

Answer 10

DQ2 ad DQ8 positive (not always)

Question 11

Treatment

Answer 11

gluten free diet
all labels
gluten in medications

can have small amounts of gluten (20 ppm)

Increased risk of mortality

Question 12

Malignant complications of Celiac disease

Answer 12

Enteropathy Associated T cell lymphoma- High grade T cell NHL, bad disease, rare disease but less raer in celiac pop

Risk normalizes on a GFD

Question 13

Tropical sprue aka environmental enteropathy

Answer 13

syndrome of stunted growth and diarrhea that is common in developing countries
Affects>150 million children world wide, malnutrition contributes to path of disorder, but supplementary feeding and vitamin supplementation are able to reverse the syndrome

Question 14

wheat allergy

Answer 14

similiar to celiac but also IgE allergic systemic causes

anaphylaxis

Question 15

non celiac gluten senstitiviety

Answer 15

patient driven disease

13%
AAs have more
Athletes

Autism, ADD, Ms schizophrenia

Wheat is high to our diet
will not have any of the classic GI celiac serology
maybe fructan?