Celiac Disease

Question 1

2 histological features of celiac disease

Answer 1

1. increased lymphocyte infiltration 2. loss or blunting of villi

Question 2

pathogenesis of celiac disease

Answer 2

1. environmental agent is gluten, which gets digested to form gliadin
2. gliadin activates the immunes system, which attacks the small intestine and leads to inflammatory damage to mucosa.

Question 3

autoantibody markers produced in celiac disease

Answer 3

1. Anti-tTG
2. endomyseal antibody (EMA)

Question 4

preferred test to look for celiac disease

Answer 4

anti-tissue transglutaminase antibody (tTG). has highest sensitivity (low chance of giivng galse negative), and high specificity (low chance of giving false positive)

ig tTG negative, need igA levels.

Question 5

essential genetic factors

Answer 5

HLA DQ2 or DQ8. these do not diagnose celiac disease, but if you don’t have these markers youre unlikely to have a celiac disease.

Question 6

how does celiac disease lead to maldigestion and malabsorption and diarrhea

Answer 6

inflammatory disruption because of cytokines and lymphocytes getting released in response to gliadin causes increased cell death, resulting in villous atrophy. without proper brush border, there is a huge amount of maldigestion because there is decreased CCK release.

decreased CCK release causes less panceas and GB contraction/activity.

overall malabsorption leads to fat malabsorption and the inability to absorb essential nutrients. the defective mucosal barrier also causes diarrhea.

Question 7

celiac disease complications

Answer 7

1 .anemia (fe deficiency, B12 or folate def, all due to decreased absorption ability)

2. osteoporosis (vit D deficeincy, Ca)
3. Malnutrition and growth retardation (delayed puberty)
4. Risk of cancer because of the higher turnover rate of villi.

Question 8

common skin condition seen in celiac disease

Answer 8

Dematitis herpetiformis.

• chronic prurutic blistering disorder.

Question 9

diagnosing celiac disease.

Answer 9

Also could do a tTG-IgA, which is very reliable especially with a positve EMA and have the celiac HLA DQ2 or DQ8.

in children, tTG-iGA is adequate to Dx, but for adults, they still require a duodenal biopsy.

DO NOT START GLUTEN-FREE DIET UNTIL BIOPSY SECURES THE Dx

Question 10

classes of celiac disease

Answer 10

1. classical celiac– has classical clinical features of malabsorption, and an abnormal biopsy
2. atypical celiac– more minor GI complants, anemia, dental enamel defects, osteoporosis, arthritis, increased ALT. often associaed with other autoimmune diseases like TYPE 1 DIABETES
3. silent celiac: the labs show celiac (tTG positice), but there are no symptoms. they have the highest rate of noncompliance because they do not feel discomfort (yet), but their mucosa is still being damaged.
4. potential celiac (modest positive serology, and normal small bowel mucosa). May also be asymptomatic but also should have a gluten-free diet.

Question 11

Why adehere to a gluten free diet?

Answer 11

1. ensure proper nutrition
2. less chance of malignancy
3. improbe managemnet of other autoimmune disorders (type 1 diabetes)
4. lessen the risk of infertility, low birthweight newborn/premies

Question 12

Why may we see refractory celiac disease (failure to improve symptoms after 2 years of a gluten free diet)

Answer 12

1. non adherance/dietary indiscretion
2. concurrent disorder (primary lactose intolerance, colitis, IBS)
3. other case of villous atrophy (Crohns)

4

Question 14

the difference between gluten sensitivty and celiac disease

Answer 14

gluten sensitivity shows prominent intestinal symptoms like bloating and diarrhea, but no intestinal inflammation on histology. Often there’s an intolerance to CHO– mainly lactose and fermentable saccharides.

TtG is NEGATIVE in someone with gluten sensitivity. Gluten sensitivity is a type of IBS, whereas celiac disease is an autoimmune disease.

Question 15

igE vs igA vs igG vs igM

Answer 15