Celiac Disease

  • Abnormal jejunal mucosa due to intestinal reaction to alpha-gliadin antigen in gluten (found in barley, rye, oats and wheat)
  • Associated with other autoimmune diseases
  • Women > men; family history; peaks in infancy and old age

Presentation

  • Malabsorption: diarrhea, weight loss, anemia, symptoms of vitamin/mineral deficiency (most severe in proximal bowel affecting Fe, Ca and folic acid)
  • Improves with gluten-free diet
  • May be associated with dermatitis herpetiformis skin eruption



 

Investigations

  • Small bowel mucosal biopsy (4-5 samples, as disease may be patchy)
    • Villous atrophy and crypt hyperplasia
    • Infiltration of the lamina propria with chronic inflammatory cells
  • Clinical response to gluten-free diet
  • Antigliadin antibodies (AGA), Antiendomysial antibodies (EMA), Tissue transglutaminase antibodies  (tTG)
  • Levels of ferritin/Fe saturation, Ca, Fe, albumin, cholesterol, carotene, B­12 – assess for malabsorption

Treatment

  • Gluten free diet – no barley, rye, oats, wheat
  • If symptoms continue consider:
    • Erroneous diagnosis
    • Gluten ingestion
    • Cow milk, soy, “food” sensitivity
    • Intestinal lymphoma
    • Concurrent disease (pancreatic insufficiency)
    • Lactase deficiency

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