Flashcards in Tutorial Cases: Celiac Deck (22):
What are classic manifestations of celiac disease? (7)
Anorexia/failure to thrive/loss of weight
What are non-GI manifestations of celiac disease?
Appear during older child to adultDerm: herpetiformis
Bone: dental enamel hypoplasia
osteopenia, short stature
Delayed puberty, Fe-deficient anemia, hepatitis, arthritis
What are disorders associated with celiac disease?
T1DM, thyroiditis, sjogren's, chronic active hepatitis, lactose intolerance, IgA deficiency
Which HLA type is strongly associated with celiac disease?
90-95% of patients have HLA-DQ2
This is present in about 20-30% of controls
What dietary factor is associated with celiac?
Modified gladden peptide-- leads to activation of CD4+ T cells in lamina propria and subsequent IFN-gamma secretion
What testing is used for celiac disease diagnosis?
Biopsy for presence of serum gladden or endomysial antibodies in small bowel of patient ingesting gluten
Remission while on gluten-free diet
Describe the histological findings for celiac disease (5)
Increased intraepithelial lymphocytes
Mixed inflammatory infiltrate
What are the important serological markers of celiac disease?
EMA (IgA): sensitive/specific
TTG (IgA): highly sensitive/specific
What is treatment for celiac disease?
A gluten-free diet
What changes in epidemiology of eosinophilic gastroenteropathies have been observed in past 20 years?
Food hypersensitivity reactions affect up to 8% children under 3 and 2.5% of general population
There has been a 3x increase in prevalence of allergies in past 20 years due to environment, food process, abx usage
What are three diseases on spectrum of eosinophilic gastroenteropathies?
Eosinophilic esophagitis presents with symptoms similar to ______, but in what way is its treatment/resolution different?
EoE presents with symptoms similar to GERD, but it is unresponsive to acid blockade and instead responds to removal of food antigen
What are clinical findings of eosinophilic esophagitis? (3)
Allergic history (asthma, rhinitis, eczema)
Slightly elevated IgE
Responsive to corticosteroids
Uncommon to have peripheral eosinophilia
What are gross findings in Eosinophilic esophagitis?
White plaques, rings/trachealization, lateral furrows
Describe epidemiology of allergic proctocolitis: Prevalence, age, sex
2-6% children in developed countries
What are clinical symptoms of allergic prococolitis? (4)
Blood streaked stools
Mild abdominal pain
Weight gain, well-appearing
What are laboratory features of allergic proctocolitis? (4)
Mild peripheral eosinophilia
Pin prick/RAST testing negative
What are provocative antigens? (3)
Cow's milk protein or soy milk
50-60% are exclusively breast fed
Describe the treatment and symptom resolution in allergic prococolitis
After foods removed, clinical symptoms improve within 72hr while diarrhea/bleeding resolve in 1-3 weeks.
Reintroduce foods later on
Describe epidemiology of eosinophilic gastroenteritis
Rare, affects all ages
What is another major cause of eosinophilia in GI tract?
Infections by parasites