GI: celiac

Question 1

General pathophys of celiac disease?

Answer 1

Gliadin (protein in gluten) deamidated by tTG –> presented by APC in HLA DQ2/DQ8 + person –> antibodies against gliadin, tTG, endomysium

Question 2

Haplotype of people with celiac disease?

Answer 2

HLA-DQ2 or -DQ8

Question 3

In active celiac disease, the intestinal wall is characterized by what 3 things?
Classification scale used?

Answer 3

Crypt hyperplasia
Villous atrophy
Intraepithelial lymphocytic infiltration
(Marsh classification)

Question 4

Is celiac disease an autoimmune disease?

Answer 4

Depends on the source! It’s more of a “hypersensitivity” because the pathological response is against an external antigen but the result is generation of anti-self Ags. Also associated w/ other AI diseases

Question 5

Characteristic rash in celiac disease

Answer 5

Dermatitis herpetiformis (5% of pts)
Usually elbows/knees pustular/itchy

Question 6

Neurological manifestations of celiac disease may include…

Answer 6

Pierpheral neuropathy
Headache
Cerebellar ataxia (lack of coordination of voluntary movements)

Question 7

If a patient w/ suspected celiac diseases is on a gluten free diet during evaluation, what must be done?

Answer 7

Gluten challenge or HLA testing (false-negatives for antibodies likely)

Question 8

Individuals with ___ that is unresponsive to treatment should be tested for celiac disease

Answer 8

Anemia

Question 9

Labs for celiac disease diagnosis

Answer 9

tTG IgA = initial/best test (S/S >95%), this is the only test to order regularly!
Total IgA to ensure no IgA deficiency (false negs)
HLA testing (2nd-line, NPV ~100%)
EMA (anti-endomysial antibody), confirmatory, higher specificity

Question 10

Endomysium = CT around….

Answer 10

myofibrils in GI smooth muscle

Question 11

If + labs for celiac or high clinical suspicion then do…

Answer 11

EDG + duodenal biopsy

Question 12

Gluten-containing things =

Safe grains?

Answer 12

BROWS
barley, rye, oats (sometimes), wheat, spelt
Rice, corn, potato, soy, millet ok!

Question 13

secondary digestive issue in most patients w/ celiac upon diagnosis?

Answer 13

Lactose intolerance
(2o lactose deficiency in active celiac due to destruction of brush border)

Question 14

Important vitamins/minerals to supplement in people with celiac?

Answer 14

Iron if deficient
Folate/B12 in all pts
Vit D/Ca in children