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NUTR 468 Clinical > Celiac Disease (Week 4 GI) > Flashcards

Celiac Disease (Week 4 GI) Flashcards

1
Q

What is celiac disease?

A

an immune-mediated enteropathy caused by a permanent sensitivity to gluten in genetically susceptible individuals
* Disease of the Small Intestine; jejunum Is major site

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2
Q

How to symptoms present in celiac disease?

A

occurs in symptomatic subjects with GI and non GI symptoms
* About 50% present Gi symptoms and 50% present with other symptoms

Occurs in some asymptomatic individuals
* screened because of risk factors

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3
Q

What are DQ2 and DQ8?

A

The HLA gene alleles that predispose a person to celiac disease
* DQ2 and/or DQ8 positive HLA haplotype is necessary but not sufficient → The majority of people who test positive for HLA-DQ2/DQ8 are at risk, but only 2% to 3% actually develop celiac disease

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4
Q

What is the environment trigger of celiac disease?

A

gluten

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5
Q

What is the autoantigen detected in celiac disease?

A

tissue transglutaminase
* The immune system mistakenly thinks that gluten — a protein in wheat, barley, rye, and oats — is a foreign invader.

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6
Q

What can result in complete resolution of celiac disease?

A

elimination of gluten

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7
Q

Diagnosis of Celiac disease

A
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8
Q

pathogensis of celiac disease

A

Presentation of modified gliadin peptide in context of HLA-DQ2 leads to activation of CD4 + T-cells (both circulate to attack foreign things)
* Also humeral response has a role

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9
Q

What is tTG and how does celiac disease affect it?

A

TTG is a normal gut enzyme that that is released during injury to fix damages but in celiac disease autoantibodies work againsts TTG correlating with active disease.
* tTG IgA antibody concentrations greater than 40 U/m correlate with celiac disease diagnosis

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10
Q

What are absorption pathophysiology complications of celiac disease?

A
  • Malabsorption of nutrients, especially iron, folate, Ca and vitamin D
  • Malabsorption of fat, fat soluble vitamins
  • Increased intestinal permeability may permit entry of other antigenic stimuli which might induce autoimmune diseases
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11
Q

prevalence of celiac disease

A
  • 1-3%, highly prevalent in South Asian, Sahara European Ancestry (pakistan probably highest)
  • 1-2/100 in Canada
  • 4-8/100 in Sweden
  • ~8/100 in India
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12
Q

risk factors for celiac disease

A
  • First degree relatives of celiac disease patients
  • Type 1 DM
  • Down syndrome
  • Turner syndrome
  • William syndrome
  • Selective IgA deficiency
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13
Q

What are typical symptoms of celiac disease?

A

62% experience typical symptoms
* Abdominal pain
* diarrhea
* failure to thrive

Reason for screening in addition → 4%

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14
Q

What are atypical symptoms of celiac disease?

A

6% experience atypical symptoms
* Iron deficiency
* headache
* tremors
* fatigue (energy delivery malfunctions)
* constipation
* depression (mental health)

Reason for screening in addition - 22%

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15
Q

How many with celiac disease might experience no symptoms?

A

~34%
* A reason for screening only

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16
Q

What is asymptomatic celiac disease often referred to as?

A

The tip of the iceberg → Can be either 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 and/or symptoms

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17
Q

What GI manifestations might occur with celiac disease?

A
  • Chronic or recurrent diarrhea
  • Abdominal distension
  • Anorexia
  • FTT or weight loss
  • Abdominal pain
  • Vomiting
  • Constipation
  • Irritability (mental health)
  • poor microbiome
18
Q

What is the most common non-GI manifestation?

A

iron deficiency anemia (3-5%)
* higher in children with newly diagnosed celiac disease anemia is common

19
Q

Aside from iron, what are other non-GI symptoms?

A
  • Hepatitis (liver disease - uncommon)
  • Arthritis
  • Epilepsy with occipital calcifications
  • Poor Bone Health and in adults ↑ risk for fracture (no evidence in children)
  • Mental Health: brain fog
  • Poor dentition (from GERD)
20
Q

What is a physical sign for celiac disease?

A

dental enamel defect
* Involve the secondary dentition
* Could be the only presenting sign of celiac disease - sometimes how kids are diagnosed
* may be from experiencing GERD

21
Q

How does celiac disease disrupt growth in children/ teens?

A

short stature and delayed puberty:
* About 10% of short children and teens have evidence of celiac disease
* Delayed menarche
* Higher prevalence in teens with untreated celiac disease
* signs of osteopenia
* poor bone development (not symptom dependent)

22
Q

What should healthy bone be composed of, and how should it grow?

A
  • New born skeleton has 25 grams of calcium → Adult skeleton has 1200 grams of calcium
  • Increase bone mass 30 x during childhood → Further 50% accrual of that to date during adolescence
23
Q

What is the importance of early diagnosis?

A
  • Improved quality (and length) of life
  • Improved growth
  • Improved learning ability
  • Decreased risk of other auto-immune disorders
  • Early diagnosis – in childhood – may decrease the risk of complications
  • Osteoporosis
  • Early diagnosis – in childhood – may increase adherence with a gluten free diet
24
Q

How is celiac disease managed?

A

Gluten free diet (GFD) remains best treatment
* Controversies over analytical methods to measure and define gluten content → <20ppm can be labelled gluten free
* Commercial recognition “value” of gluten free products
* How much can I cheat?
* The GFD has several nutritional limitations

25
Q

What is the problem with oats?

A

Oats do not contain gluten but are a problem due to high risk of contamination from nearby wheat fields and milling processes (common for them to be in proximity)
* Needs to have gluten free label; those of unknown purity should be avoided
* Contains avenin which is similar to gluten but considered okay in small amounts
* tolerance may be dose dependent - >60g/d associated with disease recurrence
* Usually recommended to avoid oats for the first 6 months-1 year of starting GF diet then can add in small amounts

26
Q

Canadian Celiac Association position on pure and uncontaminated oats?

A

Must not be introduced until disease is considered “stable”
* Must not exceed 50g to 70g (1⁄2 cup to 3⁄4 cup) daily for adults or 20 to 25g (1⁄4 cup) for children
* Gastrointestinal symptoms must be monitored during oat introduction
* Small # of individuals will not tolerate oats

27
Q

What skin condition might result from skin products containing gluten?

A

Dermatitis Herpetiformis
* Erythromatous papule → urticarial papule → tense vesicles
* Symmetrical with severe pruritis
* 90% no GIsymptoms
* Gluten sensitive
* 75% villous atrophy

28
Q

What is gluten?

A

A group of storage protein
* Wheat – gliadin
* Rye – secalin
* Barley - hordein

29
Q

What does gluten do?

A
  • Gluten forms a network which gives bread dough its elasticity (more light and fluffy)
  • Carbon dioxide trapped within the network produces light and fluffy baking
  • Gluten contributes to the chewy and soft texture of a product
30
Q

What are macronutrient concerns of GF diet?

A
  • Higher saturated fat (trying to make up for CO2 molecules not being trapped)
  • Total Sugar Intake
  • Low Fiber Intake
  • Usually higher glycemic index
31
Q

What micronutrients are at risk in GF diet?

A
  • vitamin D
  • vitamin K
  • Folate
32
Q

How does GF diet change the the food plate?

A

veggies and fruit take up more than half the plate and less given to GF grain foods to make up for lack of folate

33
Q

What supplements are reccommended in a GF diet?

A
  • Multivitamin –needs to include folate
  • Calcium
  • Vitamin D
  • Fiber (ex. Metamucil)
34
Q

What are GF grains and seeds

A
35
Q

What are gluten containing products to avoid?

A
36
Q

What are some potential non-food sources of gluten?

A
37
Q

what are common spots for cross-contamination of gluten?

A

For those following a strict gluten-free diet, cross contamination is a potential concern.
* Deep fryers, buffets, shared cutlery, toasters, peanut butter/jam jars.

38
Q

What is the importance of label reading

A
  • Always read the ingredient lists on a product to ensure it’s gluten free
  • Look for GF symbols on the product
39
Q

What are common key words for GF label reading?

A
  • whole grain oats → not gf oats
  • soluble wheat → wheat listed in ingredients
  • natural flavour → something could be hidden here
  • malt flavoring → malt = barley
  • contains soy and wheat ingredients → other area where companies have the option to list allergens
40
Q

How are GF products claimed?

A

medical expenses claim
* letter confirming celiac disease
* summary sheet of purchases
* receipts to support claim

41
Q

How to travel with CD?

A
  • Look on-line for a Celiac Chapter in the city you are travelling to → Contact chapter for restaurant info; “Google” gluten-free restaurants
  • Call the hotel/resort and explain your gluten intolerance → Ask to speak with the chef and meet upon your arrival; Many restaurants in the United States offer for the chef to come speak to you
  • Ask for a fridge for your room if you don’t have a kitchenette
42
Q

What to bring while travelling if GF

A
  • Breakfast cereal with added dried fruit, nuts and seeds
  • Loaf of toasted bread toasted with slices wrapped individually
  • Snack bars, trail mix, cheese strings
  • Condiments in Tupper-ware containers margarine, peanut butter, soy sauce, mayonnaise

NUTR 468 Clinical (34 decks)

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