Week 3: Celiac Disease

Question 1

Definition of celiac disease

Answer 1

immune mediated disease induced by the ingestion of defined proteins in subjectives who are genetically predisposed
-proteins are called prolamines, are present in dietary grains, including wheat, rye, and barley

Question 2

clinical features of classic CD

Answer 2

• presents at 6-24 months
• chronic or recurrent diarrhea
• abdominal distension
• anorexia
• failure to thrive or weight loss
• abdominal pain
• vomiting
• constipation
• irritability

Question 3

Features of late onset GI form celiac

Answer 3

• later age
• mild or intermittent diarrhea
• steatorrhea is unusual
• nausea/vomiting
• abdominal discomfort
• constipation
• change in appetite

Question 4

Extra intestinal forms of celiac

Answer 4

1. MSK: short stature and osteoporosis, arthritis, osteopenia, rickets
   - dental enamel defects
2. Skin: dermatitis herpetiformis-severe pruritus, red blisters. Pathognomonic for CD
   - recurent aphtous stomatitis
3. Repro: delayed onset of puberty, infertility
4. Heme: anemia
5. CNS: behavior changes, epilepsy, seizures

Question 5

Associated conditions with higher risk for celiac disease

Answer 5

Other autoimmune diseases
-Type I DM
-Thyroiditis
-arthritis
-primary biliary cirrhosis
Congenital disorders
-Down syndrome, Turner syndrome
-William syndrome
-IgA deficiency

Question 6

Screening tests for celiac disease

Answer 6

1. AGA IgG and IgA (antigliadin antibiodies)
   - false positives for IgG in food allergy, chronic non specific and infectious diarrhea, down syndrome, CF
   - can screen IgA deficiency
2. EMA IgA (antiendomysial) -uses human umbilical cord as substrate
   - false negatives in children
   - expensive, operator dependent, but highly sensitive and specific
3. Tissue transglutaminase antibodies
   - automated, cheap, sensitive but less specific than EMA
4. genetic testing: can be done while not being on gluten

Question 7

Serology guidelines for CD

Answer 7

-refer for biopsy if patient has positive EMA or tTG, also patient with IgA deficiency who has elevated AGA IgG

Question 8

Endoscopic and biopsy findings in celiac’s

Answer 8

• scope: scalloping, nodularity, normal appearing small intestines
• biopsy-gross: villous atrophy
• micro: villous atrophy, increased intraepithelial lymphocyte count ,crypt hyperplasia smaller crypt to villi ratio

Question 9

Complications of untreated Celiac’s disease

Answer 9

Infertility
Chronic ill health
Osteoporosis/fractures
Development of other autoimmune disorders
Mortality rate in patients with untreated celiac disease is two-fold greater at every age
Enteropathy-associated Lymphoma (EATL): primary cause of increased mortality

Question 10

gluten free grains and starches

Answer 10

Potato 
Quinoa 
Rice
Sorghum
Tapioca
Teff
Flours made from nuts, beans and seeds
Amaranth
Arrowroot 
Buckwheat 
Corn
Flax
Millet
Montina
Oats*  -but has cross contamination