Gluten Sensitivity Disorders Flashcards
What is the “classic celiac disease” presentation?
diarrhea, bloating, abd pain and wt loss
What are symptoms of “atypical” sprue?
iron deficiency osteoporosis dermatitis herpetiformis IBS DM type 1 elevated LFTs
What heritage is most commonly associated with celiac disease?
norther european descent (1/100)
What region of the GI tract is most commonly affected by celiac?
duodenum and jejunum
What are non-GI symptoms of celiac disease?
unexplained IDA folic acid/B12 deficiency reduced serum albumin unexplained elevated LFTs other autoimmune disorders (type 1 DM, thyroid dysfunction) down or tuner syndrome
What can cause difficulty in diagnosing celiac disease?
IgA deficiency
Ab levels fall on a gluten free diet
villous atrophy may be patchy
not all villous atrohpy is celiac
Describe dermatitis herpetiformis
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
What is the most common non-GI presentation of CD?
osteopenia/osteoporosis
What are some neurologic symptoms of celiac disease?
ataxia night blindness seizures headaches epilepsy mood disturbances peripheral neuropathies
What gynecologic and fertility problems can occur with celiac disease?
amenorrhea infertility spontaneous abortions intrauterine fetal growth retardation male infertility (if untreated)
How is celiac disease diagnosed?
**IgA Tissue Transglutaminase
IgA Endomysial antibody
IgA and IgG Deaminated gliadin antibodies
After an IgA tissue transglutaminase test, what is done to diagnose celiacs?
multiple biopsies
What are EGD & biopsy findings of celiac disease?
scalloping or notching on small bowel folds
small intestinal villous atrophy, intraepithelial lymphocytosis and crypt hyperplasia
What are the genetic associations of celiac disease?
95% have DQ2 heterodimer
5% have DQ8 heterodimer
-most helpful for ruling out celiacs if negative (40% europeans are DQ2/DQ8 positive)
What is a gluten free diet?
avoid all foods containing wheat, rye and barley gluten
no malt
watch for gluten in medications
What are malignant complications of celiacs?
enteropathy associated T-cell lymphoma
risk normalizes on GFD
What is the overall increased risk of death in celiac disease?
four fold increase in all cause mortality
risk normalizes on GFD
What are extra intestinal manifestations that improve with GFD?
osteoporosis IDA rash prevents development of other AI disease infertility
What is a wheat allergy?
IgE mediated true allergy
affects skin/GI tract and/or respiratory tract
What is non celiac gluten sensitivity?
patients who claim their symptoms (usuallly GI) improved with a gluten free diet
may or may not be real
Why might people feel better on a GFD even if they don’t have celiacs?
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
What are the down sides of a GFD?
no real significant down sides
may be inadequate iron, calcium, vitamin D & B
watch out for constipation
cost
What is environmental enteropathy/tropical sprue?
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
What can help with tropical sprue?
supplementary feeding and vitamin supplementation are able to reverse the syndrome
