Flashcards in Celiac Disease Deck (18):
What are 2 strong gene associations with celiac?
HLA DQ2 and DQ8
What is the pathogenesis of celiac disease?
Tissue transglutamase enzyme deaminates gluten to glutamic acid. This increases binding of gluten peptides to HLA DQ2 and 8 which increases t-cell stimulation
What is the prevalence of celiac disease?
What are some clinical features of celiac disease?
Diarrhea, foul smelling floaty stools
Growth failure, weight loss
Anaemia, neurological disorders from b vitamin deficiencies
But most present sub clinically
What are some non-gastrointestinal manifestations of celiac disease?
What cancers are celiac disease prone to?
Non Hodgkin's lymphoma
Gastro-intestinal malignancies (carcinoid, GIST, adeno carcinoma)
Lower risk of breast cancer
What are some associated conditions with celiac?
Type 1 diabetes
Selective IgA deficiency
Liver disease (PBC, PSC, hepatitis)
IBD - common gene mutation IL23R
Turners and Williams syndrome
Juvenile idiopathic arthritis
What is the risk of celiac in a first degree relative?
What is the involved in treatment for celiac disease?
Gluten free diet
Vaccination - especially those with evidence of Hyposplenism
Treat vit def - A,D, E, B12, copper, zinc, iron studies, frolic acid, carotene
What are causes of non-responders in celiac disease?
Intentional/unintentional ingestion of gluten
Concomitant lactulose intolerance
Small bowel overgrowth
What are the 2 types of refractory sprue?
Type 1 - normal population of intra-epithelial lymphocytes, good prognosis with steroids
Type 2 - pre-malignant population of lymphocytes, associated with enteropathy associated lymphoma, poor prognosis and also can develop collagenous sprue
What is the preferred serological tests for celiac disease?
IgA tissue transglutaminase
IgA anti-endomysial antibodies
What needs to be considered in testing IgA deficient patients?
Test IgG forms of antibodies instead of IgA as will give false negatives
Testing for IgG deaminated gliadin peptide antibodies are best in this situation (IgG tTG and IgG EMA are less sensitive)
When should testing for celiac occur?
When gluten is being consumed, otherwise antibodies and histology normalizes and false negative results
What are the serological markets of celiac?
IgA endomysial antibody
IgA deaminated gliadin peptide
IgG deaminated gliadin peptide
Note anti-gliadin antibodies are no longer used due to lower accuracy
What are the most sensitive and specific markets for celiac?
IgA endomysial antibody
IgA tissue transglutaminase antibody
Should patients with celiac serology and symptoms undergo endoscopy?
Yes to confirm diagnosis
Only situation when not is patients have skin biopsy proven dermatitis herpetiformis