Celiac Disease. This post will cover the points you need to know for your board exams as well as for teaching residents on the daily rounds. Please don't use the information here to treat your patients.
Also known as Celiac Sprue (to be differentiated from Tropical Sprue caused by infection during traveling which will lead to steatorrhea and folate deficiency) is cause by genetic predisposition and possibly some stressors like surgery and is trigged by consuming gluten that stimulate the immune system to cause atrophy of the small intestines lining. Treatment includes gluten-free diet.
Celiac disease is more common in individuals with autoimmune diseases like diabetes type 1, IgA nephropathy, IgA deficiency, Williams syndrome, Turner syndrome, Down syndrome and autoimmune thyroid disease.
Celiac disease causes malabsorption with vitamin (A, B3 and B12) and nutritional deficiencies (such as osteoporosis, anemia, hypocalcemia, hypophosphatemia, neuropathy, infertility and hemorrhagic disorders). It also leads to immunological consequences like dermatitis herpetiformis, atopic dermatitis, alopecia and aphthous ulcers.
The standard method of diagnosing celiac disease is the tissue transglutaminase (tTG) IgA test or IgA Endomysial antibody (EMA) (expensive and deferred to more difficult cases) "before starting the gluten-free diet" otherwise the test might come within the normal range, followed by intestinal biopsy for histologic confirmation.
In patients with IgA deficiency, the abovementioned blood tests might be falsely negative and hence if suspected test for total serum IgA to check for IgA deficiency. If present, then tTG IgG, IgG EMA or IgG antigliadin antibodies are necessary.
Mainstay of treatment is avoiding gluten in diet which comes from wheat, barley, and rye, as in bread, pasta, cereal, sauces, cake, and cookies. Some grains do not have gluten and can be eaten as oats, corn, rice, and soy. Check this gluten-free book for further recommendations.
Treatment is necessary to prevent intestinal lymphoma. If symptoms persist in spite of adherence to gluten-free diet, then intestinal lymphoma should be suspected.
The information in this post is not for patients and shouldn't be used in treating patients. Please refer to your doctor for medical advice.