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Flashcards in Gluten Intolerance Deck (21):
1

Non-GI presentations of Celiacs

Unexplained iron deficiency anemia
Folic acid or vit B12 deficiency
Reduced serum albumin
Unexplained elevated LFTs
Other autoimmune disorders
Down syndrome or Turner syndrome
Selective IgA deficiency

2

What percentage of those with Dermatitis herpetiformis will have CD?

85%

3

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

Osteopenia/Osteoporosis
*All newly diagnosed CD should have a bone density scan

4

What are some neurologic symptoms of CD from fat an vitamin malabsorption?

Ataxia (B12)
Night blindness (vitamin A)
Seizures
Headaches
Epilepsy
Mood disturbances
Peripheral neuropathies

5

What are some gynecologic and fertility problems associated with CD?

Amenorrhea
Infertility
Spontaneous abortions
Intrauterine fetal growth retardation
Male infertility reported

6

How is a diagnosis of CD made??

IgA endomysial antibody (EMA)
IgA tissue transglutaminase (tTG)
IgA and IgG deamidated Gliadin antibodies
**Anti gliadin antibodies of little value

7

What is seen on small intestine biopsy of someone with CD?

Scalloping or notching of the small bowel folds
Multiple biopsies should be obtained (6-8)
Small intestinal villous atrophy, intraepithelial lymphocytosis and crypt hyperplasia

8

What are two reasons you may get false negatives with testing for CD?

Antibody levels fall on a gluten free diet (takes about 6-8 weeks)
Celiac patients that have IgA deficiency -- might make IgA tTG and EMA falsely negative; IgG Abs useful in this case

9

What are some other things that might cause villous atrophy?

NSAIDs
Infections
IBD

10

What HLA do people with CD have?

95% have HLA DQ2
5% have HLA DQ8

11

Would you use HLA to diagnose CD?

NO!
About 40% of people with european ancestry are DQ2 or DQ8 -- but may be useful in ruling out celiacs

12

What is the treatment for CD?

Gluten free diet -- avoiding anything with wheat, rye and barley gluten; avoid malt

13

Should asymptomatic people with CD be treated?

Yes - there is a 4 fold increase in mortality (CVD and malignancy) which is likely normalized with GFD

14

What are some malignant complications of CD?

Enteropathy associated T-cell lymphoma -- high-grade T cell NHL; 5 year survival rate ~10%; occurs 20x more frequently in patients with CD
*risk of this normalizes on GFD

15

What is a wheat allergy?

Classic food allergy that affects skin, GI track and/or respiratory tract
IgE mediated disease

16

How do you diagnose wheat allergy?

Allergy pin prick testing

17

What is non-celiac gluten sensitivity?

Patients who claim they feel better on a gluten free diet -- no evidence of CD

18

Why might people feel better on a GFD?

Fermentable fractions may cause symptoms
Major change in dietary intake -- lower carb, more fruits and veggies

19

Is there a downside to eating a GFD?

not really -- may need a multivitamin
and watch for constipation if fiber is low in diet

20

What is tropical sprue?

Environmental enteropathy -- stunted growth and diarrhea that is common in developing countries
Malnutrition but supplementary feeding and vitamin supplementation are able to reverse the syndrome
Repeated bouts of diarrhea within the first 2 or 3 years of life -- no single infectious agent identified
Histologically similar to celiac disease

21

What iron salts are best absorbed??

Ferrous gluconate, ferrous sulfate