Celiac Disease

Question 1

What is celiac disease?

Answer 1

• An autoimmune disease of the small intestine characterized by an abnormal mucosa and associated with permanent intolerance to gluten in genetically susceptible individuals (HLA-DQ2/8)
• Exclusion of gluten from the diet results in clinical remission and normalization of the mucosa

Question 2

What is gluten?

Answer 2

• A protein found within grains such as wheat, rye, and barley

Question 3

What three factors are required for celiac disease to occur?

Answer 3

1) Genetics (HLA-DQ2/8)
2) Autoantigen (Tissue Transglutaminase)
3) Environmental trigger (Gluten)

Question 4

In celiac disease, villi are ___.

Answer 4

Flattened

Question 5

What is the spectrum of gluten sensitivity?

Answer 5

• Clinical presentation can range from individuals that are completely asymptomatic to those that present with muscle wasting, malnourishment and diarrhea

Question 6

What are classic symptoms of celiac disease?

Answer 6

• Abdominal pain
• Diarrhea
• Weight loss
• Poor growth
• Irritability
• Constipation
• Vomiting
• Poor appetite
• Protuberant abdomen

Question 7

What are atypical symptoms of celiac disease?

Answer 7

• Anemia
• Osteoporosis
• Short Stature
• Functional hyposplenism
• Dental Defects
• Recurrent Mouth Ulcers
• Amenorrhea
• Infertility
• Low birth weight infants
• Premature Delivery
• Atypical symptoms more common nowadays

Question 8

How prevalent is celiac disease?

Answer 8

• About 1% of world’s population, especially prevalent in Finland and Italy

Question 9

How is celiac disease diagnosed?

Answer 9

STEP 1: Serological testing 
- tTg – Anti-tissue transglutaminase
- Quantitative IgA
STEP 2: Small intestinal biopsy
- Normally taken from duodenum
- Gold standard because serology not always accurate

Question 10

What should the patient know during the diagnostic process?

Answer 10

Do not cut out gluten, otherwise intestine will heal and testing may come back negative

Question 11

What is the treatment for celiac disease?

Answer 11

• Gluten free diet for life

Question 12

What are challenges of a gluten free diet?

Answer 12

• Availability
• Cost
• Complexity
• Contamination
• Nutritionally deficiencies
• Restrictive
• Life-long
• Psychosocial implications