Coeliac Flashcards
When a celiac disease patient reaches adolescence, what beverage should be warned against?
Beer
Why is it important to give celiac disease patients a “trial of gluten” after their condition has normalized?
In some cases, gluten intolerance is transient
What grains contain gluten?
Wheat
Barley
Rye &
Oats (to a lesser extent)
What is the overwhelmingly common (80 %) presentation of celiac disease?
(4)
- FTT
- Irritability
- Explosive & foul-smelling stool
- Vomiting
At what age do celiac disease patients usually come to medical attention?
Toddlerhood
What are the main changes expected on evaluation of an intestinal biopsy in a celiac disease patient?
- Villus flattening/atrophy
- Lymphocytes in the lamina propria
- Crypt hyperplasia
What is the “classic” body habitus for a celiac disease patient?
Short kid, bloated abdomen, & wasted buttocks
Although mucosal biopsy is the gold standard for diagnosing celiac disease, what lab test is nearly as good?
Anti-tTG-IgA antibody test
A level 10× normal is expected in celiac
Why should you continue to consider celiac disease if the antibody test is negative?
Some celiac disease patients are also IgA deficient
Which possible celiac patients do not require biopsy confirmation?
Those with positive anti-TTG-IgA antibody tests
+
Celiac compatible HLA types (HLA-DQ2 or DQ8)
What hematologic abnormality is often found in celiac disease patients?
Microcytic anemia
How long should you expect to wait before a gluten-free diet improves a celiac disease patient to normal?
Up to 6 months
What oncologic diseases are celiac patients at increased risk for, if they do not stay on a gluten-free diet?
(2 general sorts)
Intestinal lymphoma
& Small bowel cancers
(and sometimes other malignancies)
What is gluten?
After starch has been extracted from wheat flour, gluten is the residue that remains. This residue is made up of multiple proteins that are distinguished by their solubility and extraction properties. For example, the alcohol-soluble fraction of wheat gluten is wheat gliadin. It is this protein component that is primarily responsible for the mucosal injury that occurs in the small bowel in patients with celiac disease. The alcohol-soluble components of barley and rye are also toxic.
What classic clinical features suggest celiac disease?
Gluten-sensitive enteropathy (celiac disease) is a relatively common cause of severe diarrhea and malabsorption in infants and children. The classic presentation of celiac disease is a 9- to 24-month-old child with FTT, diarrhea, abdominal distention, muscle wasting, and hypotonia. After several months of diarrhea, growth slows; weight typically decreases before height. Often, these children become irritable and depressed and display poor intake and symptoms of carbohydrate malabsorption. Vomiting is less common. On examination, the growth defect and distention are commonly striking. There may be a generalized lack of subcutaneous fat, with wasting of the buttocks, shoulder girdle, and thighs. Edema, rickets, and clubbing may also be seen. Many patients with celiac disease, however, have a more subtle presentation rather than the classic constellation of symptoms and can present at an older age.
What are possible nongastrointestinal manifestations of celiac disease?
- Dermatitis herpetiformis
- Iron deficiency anemia (unresponsive to treatment with oral iron supplements)
- Arthritis and arthralgia
- Dental enamel hypoplasia
- Chronic hepatitis
- Osteopenia and osteoporosis
- Pubertal delay
- Short stature
- Hepatitis
- Arthritis
What is the definitive way to diagnose celiac disease?
Definitive diagnosis of celiac disease requires multiple small bowel biopsies via endoscopy while the patient is on a gluten-containing diet. Intestinal biopsies obtained on gluten may show a number of abnormalities including villous atrophy, elongated crypts, increased crypt mitoses, increased intraepithelial lymphocytes, plasma cell infiltrate in lamina propria, absence of brush border, and disorganization and flattening of the columnar epithelium (“villous blunting”). These abnormalities should resolve fully with repeat biopsies after a strict gluten-free diet. Recent European guidelines have recommended that the need for confirmatory biopsy can be omitted in children with clear symptoms of celiac disease, with high levels of transglutaminase antibody and with positive HLA typing. Celiac disease is strongly associated with HLA-DQ types 2 and 8.
What is the mainstay of treatment for celiac disease?
A strict gluten-free diet needs to be followed throughout life, although nearly one in four patients continues to experience gastrointestinal symptoms. Gluten-free diets should be without wheat, barley, and rye. Upon initial diagnosis, most recommend avoiding oats because of contamination, but eventually most patients with celiac can tolerate oats. Good substitutions are rice and corn flour products.
