GI-Celiac Disease Flashcards
What is the MC genetic related food intolerance triggered by gluten, prolamin in wheat, rye, barley. Autoimmunie dz?
Celiac Disease
Prevalence- Western Europe, Diverse now. Europe HLA-DR3-DQ2
Serum show a rise five fold
1.4 mill unaware
1.6 gluten free diet undx
Inverse relationship
Infectious dz going down d/t vaccine, but Autoimmune Rising
Where does Celiac DZ start and damages?
mucosa of small intestine
Atrophy of villi
85% of immunity in gut. If compromised= sick
What is a mixture of proteins, hundreds, gliadin, glutenin, proline, glutamine that is resistant to pancreatic enzyme to digestion that trigger T-cell response?
Gluten Tissue transglutimase (tTG), the target auto-antigen of anti-endomycial antibodies, deaminates the glutamine residues into negatively charged glutamic acid residues increasing binding to HLA-DQ2 and DQ8
What must occur for a person to develop Celiac disease?
Allele for HLA-DQ2/8 Factors- Breastfeeding DEC CD Smoker DEC CD Recurrent infx INC CD
Binding of HLA and glutamic acid cause what?
complex immune cascade resulting in damage to mucosa of the small bowel
Gluten not broken down easily, which L/t Autoimmune response-
Triggers- Pregnancy Thyroid
Which location of stomach has most severity with Celiac Dz?
Duodenum
Small intestine has reserve
March Classification for villi damage- atrophy
How long may it take to be DX w/ CD?
98% w/ CD undiagnosed 11 yrs Female 30-60 Silent- 90% 1. 2/3 no or min GI sx 2. DDX unexplained iron dfx, ABN LFTs, IBS 3. 20% DX after 60
What are suspected symtoms with CD?
Malabsorption- Classic
1.Diarrhea-25%, steatorrhea (floaty fatty white stools), wt loss
NONClassic
- MC illness Thryoid Disease
- 40% Overweight
- Bloat, Abdominal pain** 33%
- Anorexia, Wt. Loss
- Post prandial
- MC Iron Deficiency anemia** 38%
- Osteopenia**
What are CD pt at risk for which are rare 2/2 CD?
Intussusception, small bowel lymphoma, SB carcinoma, perforation Infertility, Miscarriages
What are the neurophysiologiac symptoms
Memory GAD, MDD-MC Psychosis Ataxia Seizures HA, irritabile Autism ADHD Schizo
What test is used to diagnosie CD?
PANCE- GI-Duodenal biopsy- strong suspicion when All + serum, IgA-AGA, DGP* best for CD
PCP**IgA anti-human tissue transglutimase (tTG) -
NO one test b/c must be on gluten diet
Total lgA
EMA-epithelial membrane antigen, A mucus, Deficient in CD
Once a CD pt is diagnosed, How long will it take for Antibody test to be negative?
6-12mo upt 5 yr 80-90% will be negative
GFD- 70% sx improved 2wk
What should be consider in patients with iron deficiency, folate deficiency, malabsorption, THyroid dz, fatigue, unexplained weight-loss, idiopathic LFTs, refractory “functional” symptoms
Celiac Disease
What is the only treatment for CD?
Gluten free diet- <20mil part NO RX Level unknown Diet counseling** Challenging-for kids Cost PTSD- denial, anger, MDD
Mrs. Flour has DX w/ CD d/t persistent sx of bloat and HA. What is the ideal follow up.
2y be reassessing intestinal mucosa -2-9y
Retest Anti-tTG 6-12mo, 5y should be DEC
If a patient still has sx even with compliance what should be done?
NRCD- MC
Misdiagnosis
Inadvertent exposure
Refer GI
Ms. flour daughter c/c “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue. What is DX?
nonceliac gluten sensitivity (NCGS) - maybe a spectrum mild mod severe CD.
What would be next steps for her daughter with nonceliac gluten sensitivity (NCGS) ?
recommendation of a GFD trial for refractory(unmanagable) IBS patients is not unreasonable
How does CD affect skin?
dermaititis herpetiformis
aphtlous stomaitits
hair loss
How is CD assoc with LFTs and liver dz?
Autoimmune hepatitis- 4%
PBC-Primary biliary cholangitis -6%
Primary sclerosing cholangitis- rare
What type of CA are related to CD?
NOn Hodgkin lymphoma
Small Intestine Cancer
Colon Ca
Basal cell carcinoma
What extraintestional manifestation in the head was improved with GFD?
Migraine
