24. Gluten Sensitivity Flashcards Preview

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Flashcards in 24. Gluten Sensitivity Deck (30):
1

What is the presentation of classic celiac disease?

Diarrhea
Bloating
Abdominal pain
Weight loss

2

What are the components of atypical sprue?

Iron deficiency
Osteoporosis
Dermatitis herpetiformis
IBS
DM type I
Elevated LFTs

3

What is the prevalence of CD in people of Northern European descent?

1 in 100

4

What is the prevalence of CD in the following at-risk populations:
- With first degree relative with CD
- Second degree relative
- Monozygotic twin
- HLA id sibling

1 in 10
1 in 39
70-80%
40%

5

What is the area of the bowel that is most commonly affected by celiac disease?

duodenum
proximal jejunum

6

What vitamin deficiencies are often seen with celiac disease?

Iron deficiency
Folic acid deficiency
B12 deficiency

7

Why is reduced serum albumin seen with celiac disease?

Chronic malnourishment

8

What are other auotimmune disorders are associated with celiac disease?

Type I DM (2-15%) *
Thyroid dysfunction (2-7%) *
Addison disease
PBC
Sjogren's
AI hepatitis

9

What two genetic defects are associated with celiac disease?

Down syndrome
Turner syndrome

10

Patients with celiac disease often have selective deficiency of what Ig?

IgA
**9% of all IgA deficient patients have CD

11

What is dermatitis herpetiformis?

Pruritic papulovesicles on the extensor surfaces of the extremities and trunk

12

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

Osteopenia in 70% of patients with untreated CD
Osteoporosis in 25% of all CD patients
**all patients with CD should have bone density scan

13

What are the neurologic sx of CD?

Ataxia (B12 def)
Night blindness (vit A)
Seizures
Headaches
Epilepsy
Mood disturbances
Peripheral neuropathy

14

Gyneocologic and fertility problems with CD

- Amenorrhea in 1/3 untreated CD
- Infertility common in untreated CD
- Spontaneous abortions
- Intrauterine fetal growth retardation

15

What happens to gluten in the intestines?

Degraded into gliadin
Tissue transglutaminase deaminates gliadin
HLA DQ2 or DQ8 presents deaminated gliadin to T cells
B cells make anti-gliadin, anti-endomysium, anti-tTG antibodies

16

What are the most powerful and clinically useful tests for suspected celiac disease?

IgA endomysial antibody (EMA)
IgA tissue transglutaminase (tTG)
IgA and IgG DEAMINATED gliadin antibodies

17

If a small intestine biopsy is done in an adult with suspected CD, what will be seen?

1. Scalloping or notching of the small bowel folds
2. Villous atrophy
3. Intraepithelial lymphocytosis
4. Crypt hyperplasia (deepening)

18

What are two main reasons that one might get false negatives for CD serologic testing?

1. Antibody levels fall on a gluten-free diet: may fall within a day with mild disease, usually 6-8wk
2. Celiac patient that is IgA deficient

19

What is the best way to assess CD in a celiac patient that is IgA deficient?

IgG deaminated gliadin antibody
*can also look at biopsy

20

Pitfall of looking for villous atrophy for CD dx is that other things cause it:

NSAIDs
Infections
IBD

21

What HLA is CD associated with?

DQ2 heterodimer (95%)
DQ8 heterodimer (5%)

22

What is HLA DQ2/8 useful for?

40% people with european descent have the genes, but it is useful in ruling out CD
**if someone doesn't have DQ2/8, the don't have CD

23

Rules for the gluten free diet

Avoid foods with wheat, rye, barley gluten
Avoid malt
Read labels, look for gluten in meds

24

What malignancy is most commonly associated with CD?

High-grade T cell NHL: entropathy associated T-cell lymphoma

25

entropathy associated T-cell lymphoma occurs __x more frequently in patients with CD?

20
**risk normalizes on GFD

26

What is a wheat allergy?

CLASSIC food allergy affecting skin, GI tract, and resp tract
IgE mediated
No antibodies, normal intestinal mucosa

27

How is wheat allergy dx made?

Allergy pin prick testing

28

Why do people feel better on a GFD?

Major change in dietary intake
Fermentable fructans may cause sx

29

What are the downsides to a GFD?

Inadequate iron, calcium, vitamin B, and B vitamins
Low in fiber (watch for constipation)
Difficult to eat out/social stigma
Cost

30

What is environmental enteropathy/tropical sprue?

Syndrome of stunted growth and diarrhea that is common in developing countries
--malnutrition contributes to pathogenesis
--recurrent diarrhea est cycle of mucosal injury, malnutrition, infection, and inflammation