Celiac Disease

Ryan Sanford3/30/10

Key Points

• Gluten Sensitive Enteropathy• Malabsorption, extra-GI effects• Dx w/: serology, biopsy, gluten restriction• Consider with: DM1, Fe-deficient, infertile,

bad osteoporosis, IBS, autoimmune thyroid disease, chronic GI Sx

• MAKE the diagnosis prior to lifetime gluten restriction!

The spectrum of pathology – partially reflecting state of gluten exposure

Architectural Distortion

Dermatitis Herpetiformis

• THE physical exam finding• Itchy, vesiculo-bullous rash of extensors, trunk,

intrascapular region

Often treated with dapsone only, but gluten should be removed from diet

Associations

• DM type 1• Autoimmune thyroid disease• Down syndrome• Selective IgA deficiency• Infertility• Atrophic glossitis• Iron deficiency• Metabolic bone disease – early/severe osteoporosis• CNS: peripheral neuropathy, cerebellar disease, ?

anxiety/depression

Serology – how good is it?

• As good as the diet: if avoiding gluten, titers drop false negatives!

• Best = IgA tissue transglutaminatse or IgA endomysial Ab. o EMA: LR+33; LR- 0.02o tTG: LR+ = 15.8; LR- = 0.05 o Gliadin Ab LR+ = 4; LR- = 0.25

• Antigliadin Ab test: not as Sn/Sp; avoid• Almost all w/ 1) positive serology or 2) those with negative

serology but strong suspicion should have small bowel biopsy• If still negative: IgA deficient? – check IgG tests, avoiding gluten

already?, return to DDx.

Treatment – deceptively simple

• Complete removal of gluten from dieto Wheat, rye, barley, oats

References

• ACP Pier• Up To Date