Celiac Disease & Gluten Free Diet

Question 0

Gi manifestations

Answer 0

• chronic or recurrent diarrhea
• abdominal distension
• anorexia
• FTT or weight loss
• abdominal pain
• vomiting
• constipation
• irritability

Question 1

Genes and Antibodies

Answer 1

genes: DQ2 and DQ8 positive HLA haplotype is necessary but not sufficient
- both environmental trigger (gluten) and the autoantigen “Tissue Transglutaminase” are known

• presentation of modified gliadin peptide in context of HLA-DQ2 leads to activation of CD4+ T cells
• TTG is a normal gut enzyme released during injury
• autoantibodies against TTG correlate with the active disease

Question 2

non Gi manifestations

Answer 2

• iron deficiency anemia resistant
• hepatitis
• arthritis
• epilepsy with occipital calcifications

Question 3

Asymptomatic

Answer 3

• can either be silent or latent celiac disease
  silent: no or minimal symptoms, damaged mucosa and positive serology
  latent: no symptoms, normal mucosa and may show positive serology; will develop later mucosal changes or symptoms

Question 4

Complications

Answer 4

• short stature
• dermatitis herpetiformis
• permanent dental enamel hypoplasia
• recurrent stomatitis
• fertility problems
• depression/anxiety
• learning problems
• osteoporosis
• intestinal lymphoma
• refractory celiac disease and related disorders

Question 5

Developing Bones

Answer 5

• increase in bone mass 30x during childhood
• further 50% further during adolescence
• bone is more sensitive to calcium and vitamin D status more than hormones
• 50-70% of pt with celiac disease have low bone mass
• 30% have osteoporosis
• fracture risk increases 2-3x in adults with celiac disease
• 40-50% of children with CD may have low bone mass
• normal bone mass is restored with GF diet

Question 6

What is gluten?

Answer 6

• a group of storage proteins
• wheat –> gliadin
• rye –> secalin
• barley –> hordein
• gluten is a grain that is stored in the endosperm

Question 7

What is Gluten Free?

Answer 7

• gluten level does not exceed 200ppm in USA and 20 ppm in Canada

Question 8

What does gluten do?

Answer 8

• forms a network which gives bread elasticity
• traps carbon dioxide within the network
• causes damage to your SI because body doesn’t recognize gluten and so the intestine immune system autodigests the microvili causing inflammation and malabsorption

Question 9

Gluten and Malabsorption

Answer 9

• gluten triggers an immune reaction
• immune system destroys cells lining the SI
• area available for absorption decreases
• intestinal biopsy blood test is the gold standard
• marsh lesions 1,2, 3 or 4

Question 10

Gluten Free Grains and Seeds

Answer 10

• amaranth
• buckwheat/kasha
• quinoa
• dense, lots of calories, low in b vitamins, and no fortifications, low in fibre
• spelt has a low gluten level
• oats don’t contain gluten but become contaminated through milling –> no more than 1/2 to 3/4 cup a day for adults or 1/4 cup for children
• deli, bakery, bulk foods, beer and cross contamination is not labelled

Question 11

Supplements for GF diet

Answer 11

• multivitamin for B vitmains
• calcium
  vitamin D ~ helps absorb Ca
• fibre
• divalent minerals are absorbed in the duodenum
• low D can put you at risk for other autoimmune diseases

Question 12

Recommended investigations

Answer 12

• DEXA bone mineral density test to determine baseline bone density
• blood tests for folic acid, vitamin D and iron
• water soluble vitamins absorb in jejunum
• fat soluble absorbs (b vitamins) in the ilium