Flashcards in Gluten Intolerance Deck (21):
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
What percentage of those with Dermatitis herpetiformis will have CD?
What is the most common non-GI presentation of CD?
*All newly diagnosed CD should have a bone density scan
What are some neurologic symptoms of CD from fat an vitamin malabsorption?
Night blindness (vitamin A)
What are some gynecologic and fertility problems associated with CD?
Intrauterine fetal growth retardation
Male infertility reported
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
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
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
What are some other things that might cause villous atrophy?
What HLA do people with CD have?
95% have HLA DQ2
5% have HLA DQ8
Would you use HLA to diagnose CD?
About 40% of people with european ancestry are DQ2 or DQ8 -- but may be useful in ruling out celiacs
What is the treatment for CD?
Gluten free diet -- avoiding anything with wheat, rye and barley gluten; avoid malt
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
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
What is a wheat allergy?
Classic food allergy that affects skin, GI track and/or respiratory tract
IgE mediated disease
How do you diagnose wheat allergy?
Allergy pin prick testing
What is non-celiac gluten sensitivity?
Patients who claim they feel better on a gluten free diet -- no evidence of CD
Why might people feel better on a GFD?
Fermentable fractions may cause symptoms
Major change in dietary intake -- lower carb, more fruits and veggies
Is there a downside to eating a GFD?
not really -- may need a multivitamin
and watch for constipation if fiber is low in diet
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