Gluten Sensitivity Disorders

Question 1

What is the “classic celiac disease” presentation?

Answer 1

diarrhea, bloating, abd pain and wt loss

Question 2

What are symptoms of “atypical” sprue?

Answer 2

iron deficiency
osteoporosis
dermatitis herpetiformis
IBS
DM type 1
elevated LFTs

Question 3

What heritage is most commonly associated with celiac disease?

Answer 3

norther european descent (1/100)

Question 4

What region of the GI tract is most commonly affected by celiac?

Answer 4

duodenum and jejunum

Question 5

What are non-GI symptoms of celiac disease?

Answer 5

unexplained IDA
folic acid/B12 deficiency
reduced serum albumin
unexplained elevated LFTs
other autoimmune disorders (type 1 DM, thyroid dysfunction)
down or tuner syndrome

Question 6

What can cause difficulty in diagnosing celiac disease?

Answer 6

IgA deficiency
Ab levels fall on a gluten free diet
villous atrophy may be patchy
not all villous atrohpy is celiac

Question 7

Describe dermatitis herpetiformis

Answer 7

pruritic
papulovesciles
extensor surfaces of extremities and trunk
~85% pts w/ will have celiac disease
usually responds to gluten free diet even if not associated w/celiac disease

Question 8

What is the most common non-GI presentation of CD?

Answer 8

osteopenia/osteoporosis

Question 9

What are some neurologic symptoms of celiac disease?

Answer 9

ataxia
night blindness
seizures
headaches
epilepsy
mood disturbances
peripheral neuropathies

Question 10

What gynecologic and fertility problems can occur with celiac disease?

Answer 10

amenorrhea 
infertility 
spontaneous abortions
intrauterine fetal growth retardation
male infertility
(if untreated)

Question 11

How is celiac disease diagnosed?

Answer 11

**IgA Tissue Transglutaminase
IgA Endomysial antibody
IgA and IgG Deaminated gliadin antibodies

Question 12

After an IgA tissue transglutaminase test, what is done to diagnose celiacs?

Answer 12

multiple biopsies

Question 13

What are EGD & biopsy findings of celiac disease?

Answer 13

scalloping or notching on small bowel folds

small intestinal villous atrophy, intraepithelial lymphocytosis and crypt hyperplasia

Question 14

What are the genetic associations of celiac disease?

Answer 14

95% have DQ2 heterodimer
5% have DQ8 heterodimer
-most helpful for ruling out celiacs if negative (40% europeans are DQ2/DQ8 positive)

Question 15

What is a gluten free diet?

Answer 15

avoid all foods containing wheat, rye and barley gluten
no malt
watch for gluten in medications

Question 16

What are malignant complications of celiacs?

Answer 16

enteropathy associated T-cell lymphoma

risk normalizes on GFD

Question 17

What is the overall increased risk of death in celiac disease?

Answer 17

four fold increase in all cause mortality

risk normalizes on GFD

Question 18

What are extra intestinal manifestations that improve with GFD?

Answer 18

osteoporosis 
IDA
rash
prevents development of other AI disease
infertility

Question 19

What is a wheat allergy?

Answer 19

IgE mediated true allergy

affects skin/GI tract and/or respiratory tract

Question 20

What is non celiac gluten sensitivity?

Answer 20

patients who claim their symptoms (usuallly GI) improved with a gluten free diet
may or may not be real

Question 21

Why might people feel better on a GFD even if they don’t have celiacs?

Answer 21

major change in dietary intake (lower carb, more fruits/veggies)
withdrawal of gluten may inadvertently be reducing the ingestion of fructans that may actually be causing symptoms
withdrawwal of fermentable oligosaccharides, disaccharides, monosaccharides and polyols in IBS

Question 22

What are the down sides of a GFD?

Answer 22

no real significant down sides
may be inadequate iron, calcium, vitamin D & B
watch out for constipation
cost

Question 23

What is environmental enteropathy/tropical sprue?

Answer 23

syndrome of stunted growth and diarrhea that is common in developing countries
repeated bouts of diarrhea withing hte first 2-3 years of life
no single infectious agent
histologically similar to severe celiac
recurrent diarrhea establishes a cycle of mucosal injury, malnutrtion, infection and inflammation

Question 24

What can help with tropical sprue?

Answer 24

supplementary feeding and vitamin supplementation are able to reverse the syndrome