Celiac disease Flashcards
What are the triggers for celiac
Gliadin which is a component of gluten found in wheat, barley, rye
Genetic correlation of celiac
HLA-DQ2/DQ8
Epidemiology of celiac disease
5-10 % rush if one parent has celiac, 10-20% if one sibling has celiac
Female: male 2:1
What are the patterns of celiac disease
1 - classic → (malabsorption) diarrhea, steatorrhea, wt loss, growth failure , abdominal distension/pain, anorexia, delayed puberty / short stature, + extra intestinal (irritability, dermatitis herpetiformis)
2- non-classic → chronic constipation, persistent vomiting, IBS + extra intestinal (hematologic, neurologic, hepatic, gynecologic, MSK, oral & dental, osteoporosis, hyposplenism
3-sub clinical → No signs or sx that wouldtrigger investigations. Dx based on screening due to risk factors
4 - potential → abnormal antibodies but normal intestinal histology- may develop lesions over time
Risk factors and associated conditions with celiac
Downs syndrome
Turners syndrome
Autoimmune thyroiditis
Autoimmune hepatitis.
IgA deficiency
Type I DM
First degree relative with celiac
Pediatric signs and symptoms of celiac disease
Anorexia
Chronic constipation
Delayed puberty / growth failure
Irritability
Recurrent vomiting
Complications of celiac disease
Nutritional deficiencies
Growth failure
Osteoporosis
Autoimmune discuders, malignancies (possible)
When should testing for celiac disease be considered
- Presence of a rick factor
- presence of any of the following sx
1-abdo pain / bloating
2 - chronic diankea/constipation/ibs
3- unexplained wt loss
4-chronic fatigue
5- dental enamel defects
6- dermatitis herpetiformis
7 - recurrent aphthous stomatitis
8- iron deficiency anemia /abnormal LFTs
9- infertility epilepsy/ ataxia / peripheral neuropathy
Investigations for celiac disease
- serum IgA
- serum Anti TTG IgA
-Anti DGP IgG (deamidated gliadin peptide) if IgA deficiency - < 2 y/o → anti TTG IgA and anti DGP IgA and IgG
- biopsy + histology (intestinal or dermatitis herpetiformis lesion) for confirmation
- HLA DQ2/DQ8 testing
Patient must be on gluten containing diet for at least 1-3 month prior to testing
What is the algorithm for testing of celiac proposed by ACG
If anti TTG Iga > 10x ULN and IgA normal → confirm with repeat antiTTG IgA and EMA. If repeat <10x or EMA negative → order histology
If anti TTG IgA < 10 x or IgA low → order histology/ biopsy
Interpretation of results of celiac testing
Serology and histology positive → celiac confirmed
Serology +, histology - → repeat serology with or without report histology. can consider HLA testing
Serology -, histology + → consider alternate dx. If none, trial celiac diet, HLA testing
Serology -, histology - → celiac excluded
If patient was on gluten free diet pier to testing → start glut en containing diet ( atleast 3 slices of toast ) 1-3 mo prior to testing or consider HLA testing
Management of celiac disease
1 - diet → Gluten free diet for life, refer to dietician
2- deficiencies → test and treat with supplements.
3. Bone health → BMD
4. Screen 1st degree relatives
5. Screen for sx resolution + retest serology in 6 mo. if refractory sx consider gluten ingestion, alternate dx. Consider corticosteroids due to increased risk of T cell
Lymphoma.
Monitoring of patient with celiac
Annual Anti TTG
Q 2yr TSH
Q1yr ALT,AST if previously elevated
Which antigens are present in celiac disease
Tissue transglutaminase
Gliadin
Endomysium
Deamidated gliadin peptide
Investigation of bone health in celiac disease
Dx of celiac → serum calcium, vit d, PTH, calcitonin
Celiac with malabsorption → BMD
Celiac without malabsorption → BMD if high risk
At follow up:
Anti TTG + vit D at 1 year
BMD Q 2yr if not adhering to diet or results abnormal at baseline
Assess calcium and vit D intake
