Celiac Sprue Common cause of malabsorption of one or more nutrients in Caucasians, especially those of European descent Also known as non-tropical sprue,

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Celiac Disease This session introduces you to the intestinal malady known as celiac disease or celiac sprue. There are three reasons for looking at this.

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Celiac Sprue Common cause of malabsorption of one or more nutrients in Caucasians, especially those of European descent Also known as non-tropical sprue, celiac disease (in children), adult celiac disease, and gluten-sensitive enteropathy Onset of symptoms  1 st yr of life – 8 th decade Source: Harrison’s Principles of Internal Medicine, 17 th ed.

Celiac Sprue Hallmark: abnormal small intestinal biopsy and the response of the condition to the elimination of gluten from the diet (correlation of symptoms to the histologic change) Histologic changes  proximal to distal distribution of severity Source: Harrison’s Principles of Internal Medicine, 17 th ed.

Celiac Sprue Symptoms may appear w/ introduction of cereals in an infant’s diet In many patients, there is frequent spontaneous remissions and exacerbations Source: Harrison’s Principles of Internal Medicine, 17 th ed.

Celiac Sprue Symptoms: Significant malabsorption of multiple nutrients Diarrhea Steatorrhea Weight loss Consequence of nutrient depletion (i.e – anemia) *There may also be an absence of symptoms but a patient may still have evidence of depletion of a single nutrient (i.e – iron or folate deficiency) Source: Harrison’s Principles of Internal Medicine, 17 th ed.

Celiac Sprue Etiology: Environmental  association w/ gliadin, a component of gluten present in wheat, barley, and rye Immunologic  serum antibodies (IgA antigliadin, IgA antiendomysial, IgA anti-tTG antibodies) are present Source: Harrison’s Principles of Internal Medicine, 17 th ed.

- Antiendomysial antibody  90-95% sensitivity, 90-95% specificity; antigen recognized is tTG Genetic  high in Caucasians, low in Blacks and Asians; 10% in 1 st degree relatives; almost all patients express HLA-DQ2 allele Source: Harrison’s Principles of Internal Medicine, 17 th ed.

Celiac Sprue Diagnosis: Small intestinal biopsy is required Presence of characteristic histologic changes in the biopsy w/ a prompt clinical and histologic response to a gluten-free diet Source: Harrison’s Principles of Internal Medicine, 17 th ed.

Celiac Sprue Histologic Changes: Absence or reduced height of villi  flat apperance Increased loss of villous cells associated w/ an increase crypt cell proliferation  crypt hyperplasia and loss of villous structure  villous atrophy Source: Harrison’s Principles of Internal Medicine, 17 th ed.

Celiac Sprue Cuboidal appearance and nuclei that are no longer oriented basally in surface epithelial cells and increased intraepithelial lymphocytes Increased lymphocytes and plasma cells in the lamina propria Source: Harrison’s Principles of Internal Medicine, 17 th ed.

A.Normal individual. B.Untreated celiac sprue. C. Treated celiac sprue. D. Intestinal lymphangiectasia. E. Whipple's disease. F. Lymphoma. G. Giardiasis. Source: Harrison’s Principles of Internal Medicine, 17 th ed.

Celiac Sprue Complications: Cancer Intestinal ulceration independent of lymphoma Refractory sprue Collagenous sprue Source: Harrison’s Principles of Internal Medicine, 17 th ed.