Celiac Disease

Question 1

What is the estimated incidence of celiac disease?
a) 5%
b) 2%
c) 1%
d) 0.1%
When is the most common period of presentation for celiac disease?
a) Between 2 and 5 years of age
b) Between 6 months and 2 years of age
c) In adolescence
d) In adulthood
Which component of gluten is considered the most pathogenic in celiac disease?
a) Barley
b) Rye
c) Gliadin
d) Wheat

Which enzyme deamidates gliadin in the context of celiac disease?
a) Amylase
b) Lactase
c) Tissue Transglutaminase (tTG)
d) Lipase
In celiac disease, deamidated gliadin is presented by antigen-presenting cells via which major histocompatibility complex (MHC) class?
a) MHC class I
b) MHC class II
c) MHC class III
d) MHC class IV
When deamidated gliadin activates helper T CD4+ cells, what is the downstream effect?
a) Inhibition of B-cell activity
b) Suppression of immune responses
c) Activation of B-cell, leading to the production of antibodies
d) Formation of memory T cells
Which type of T cells, when activated, release cytokines that mediate further damage in celiac disease?
a) Th1 cell
b) Cytotoxic T CD8+ cells
c) Natural killer cells
d) Regulatory T cells

What HLA types are most commonly associated with celiac disease?
a) HLA-DQ2 (95%) and DQ8
b) HLA-A and HLA-B
c) HLA-DR3 and DR4
d) HLA-C and HLA-E

Gluten sources:

Answer 1

C
B
C
C
B
C
A
A
wheat, rye, barley, and related grains

Question 2

Celiac disease is seen in association with:

Answer 2

❖ IgA deficiency : seen in 2-3% patient with celiac disease
❖ Type 1 diabetes
❖ Autoimmune thyroiditis
❖ Addison disease
❖ Turner syndrome
❖ Trisomy 21

Question 3

Clinical Manifestations of celiac disease

Answer 3

❖ Symptoms can begin at any age when gluten-containing foods are given.
Causes malabsorption and malnutrition

Question 4

Typical Presentation of celiac disease

Answer 4

➢ Diarrhea
➢ Constipation
➢ Abdominal bloating
➢ Failure to thrive
➢ Irritability
➢ Decreased appetite
➢ Ascites caused by hypoproteinemia

Question 5

Atypical Presentation of celiac disease

Answer 5

Dermatitis herpetiformis (pathognomonic for celiac)→ Due to IgA deposition at the tips of dermal papillae
Dental enamel hypoplasia
Aphthous ulcers: regress once the patients are on a gluten-free diet.
Delayed tooth eruption
Neurological problems:
✓ Celiac disease may cause occipital calcifications and intractable epilepsy
✓ These patients can be resistant to antiseizure medicines
✓ Can benefit from a gluten-free diet if it is started soon after onset of seizures.

Question 6

Histology of celiac disease

Answer 6

Histology:

❖ Villous atrophy, crypt hyperplasia , intraepithelial lymphocytosis.
❖ Marsh classification:

TYPES

0. Normal duodenal biopsy

I. Normal mucosal architecture with increase intraepithelial lymphocytes

II. Hyperplastic crypts but near normal villi

IIIa Hyperplastic crypts with partial villous atrophy

IIIb Hyperplastic crypts with subtotal villous atrophy

IIIc. Hyperplastic crypts with total villous atrophy

Question 7

Diagnosis test and treatment of celiac disease
الصوره

Answer 7

D-xylose test:
❖ Xylose Passively absorbed in proximal small intestine , only need intact mucosa
❖ Abnormal in celiac disease

• Diagnosis:

❖ Serology:
➢ IgA anti- tTG: high sensitivity (99%) & specificity (>90%)
➢ Anti-endomysial
➢ Antideamidated gliadin peptide antibodies.
❖ Duodenal Biopsy:
➢ Gold standard
➢ Take multiple biopsies

• Treatment:
❖ Life-long Gluten-free diet.