Celiac Disease
last authored: Oct 2009, Dave LaPierre
Introduction
Celiac disease, or 'gluten-sensitive enteropathy', is an allergy to the protein gluten found in wheat, barley, rye, and other grains.
It has an incidence of 1:80-300 in children. It usually presents at 6-18 months as wheat is introduced into the diet, but can occur at any age.
Celiac disease tends to be diagnosed by gastroenterologists.
The Case of...
Causes and Risk Factors
Pathophysiology
Allergy to gluten causes immune-mediated inflammation and destruction of absorptive villi.
type 0 - pre-infiltrative
type 1 - infiltrative (leukocytes)
type 2 - hyperplastic
type 3 - destructive
type 4 - hypoplastic
IgA is not the offending antibody
Signs and Symptoms
- history
- physical exam
History
failure to thrive in infants and children
fatigue, irritability
diarrhea, steatorrhea
nausea, vomiting, abdominal pain
edema
weight loss
vitamin deficiency
iron deficiency (absorbed in the duodedum)
Physical Exam
Wasted muscles, distended abdomen, flatt buttocks
clubbing
rickets
non-GI manifestations (edit this list)
neuropsychoatric disorders - depression, psychosis
arthritis
osteoporosis
hyposplenism
dermititis herpetiformis
diabtetes
IgA deficiency
Down's syndrome
liver disease
thyroid disease
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
anemia can be present
tissue transglutaminase (tTG) (95% sensitivity and specificity)
- if the test is positive, refer the patient for small bowel biopsy
other antibodies: antigladin, antiendomyseal
fat malabsorption studies
small bowel biopsy (scope and 4-6 biopsies)
Diagnostic Imaging
Differential Diagnosis
Treatments
Diet modification
wheat, rye, barley, and perhaps oats must be avoided, for life in some cases.
inadvertent contamination can be a big problem
address nutritional deficiencies
iron, B12
in severe cases, calcium, magnesium, and electrolytes
monitor response
role of tTG screening is not known
biopsy should be repeated in 6-12 months
Consequences and Course
Complications include:
- malnutrition, failure to thrive
- small bowel lymphoma
The Case of...
Additional Resources
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