1 / 9

Celiac Disease

Celiac Disease. Ryan Sanford 3/30/10. 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

oona
Download Presentation

Celiac Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Celiac Disease Ryan Sanford 3/30/10

  2. 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!

  3. The spectrum of pathology – partially reflecting state of gluten exposure

  4. Architectural Distortion

  5. 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

  6. 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

  7. 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. EMA: LR+33; LR- 0.02 tTG: LR+ = 15.8; LR- = 0.05 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.

  8. Treatment – deceptively simple Complete removal of gluten from diet Wheat, rye, barley, oats

  9. References ACP Pier Up To Date

More Related