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
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