Celiac

disease
By: Dr. Hira Salman
General consideration

Celiac disease also called celiac sprue

gluten enteropathy.  it is a most
common and often undiagnosed type
of malabsorption. it is presented as
Celiac disease affects women more
permanent disorder caused by
often than men 3 : 2 and is
immunological response to gluten,
associated with the haplotypes HLA
high molecular weight storage
DR3 and HLA-DQW2. 
protein found in wheat rye and Barley
that results in diffuse damage to the
proximal small intestine mucosa with
malabsorption of nutrients.
Sign and symptoms

Chronic diarrhea 50%  Steatorrhea  Bloating Weight loss

Dermatitis herpetiformis
occurs  less than 10% pruritic
papular vesicular rash on
Abdominal pain  Anemia 
extensors surfaces of
extremities,  trunk,  scalp and
neck
Isolated abnormality
Unexplained iron Early onset of
in liver chemistry Coagulopathy  Weakness 
deficiency anemia osteoporosis 
test 

Growth retardation
more commonly Dyspepsia Flatulence Fatigue  Depression 
present in infants 

Hyperkeratosis due
Easy bruising due to
Delayed puberty Amenorrhea Reduce fertility to vitamin E
vitamin K deficiency
deficiency

Neurologic signs
(peripheral
Bone pain due to neuropathy, ataxia
osteomalacia due to vitamin B12
and vitamin E
deficiency
About 40 % of patients
show no symptoms 
Diagnostic investigations

1.  2. 3.
Routine Serologic Mucosal
lab tests test biopsy
 1.  Routine lab test

Vitamin B12 ,
Vitamin B6 , zinc Alkaline
Serum folate  Serum calcium
aminotransferas phosphatase 
es 

Dual energy x- Vitamin A and

PT Serum albumin
ray  Vitamin D levels 
2. Serologic Tests 

In patient with IgA deficiency

test that measure IgG
antibodies to tissue
IgAtTG ( tissue
IgAlevel in case of negative transglutaminase or to
transglutaminase 98% sensitive HLA-DQ2/DQ8 testing
IgAtTG deamidated gliadin
and 99% specific)
peptide( anti DGP) have
excellent sensitivity and
specificity
3.  Mucosal biopsy

Endoscopic mucosal biopsy of the proximal duodenum  is

the standard method for confirmation of the diagnosis
Findings of mucosal biopsy in celiac
disease

At endoscopy atrophy or scalloping of the duodenal folds

Intraepithelial lymphocytosis alone to  extensive infiltration of the lamina

propria with lymphocytosis and plasma sells,  hypertrophy of the
intestinal crypts  and blunting  or complete loss of intestinal Villi

Partial or complete reversion of the abnormalities occurs within 3 to  24

months after a patient is placed on a gluten free diet but symptom
resolution remains incomplete in 30% of patients
 Irritable bowel syndrome
Tropical sprue

Differential Bacterial overgrowth

diagnosis Cow's milk intolerance 
Viral gastroenteritis
Eosinophillic gastroenteritis
Gastrinoma 
Whipple disease
Lactase deficiency
Treatment

Adhering to a gluten free diet

Any deficiencies should be treated 

For severe cases glucocorticoids TPN and

immunosuppressants can be administered

Anti-inflammatory medication screening for osteoporosis

 If appropriately diagnosed and treated
patient with celiac  disease have an
excellent prognosis
Complications include refractory sprue
Complication
s and
prognosis Ulcerative jejunitis 

Enteropathy associated with T cell

lymphoma 

Intestinal adenocarcinoma
Conditions associated with celiac
disease

1. 
2. 
Autoimmune
Malignancy
disorders
1.  Autoimmune disorders

Autoimmune Thyroid disease

Addison's disease

Hypoparathyroidism 

Pernicious anaemia

Type 1 Diabetes mellitus

 Intestinal enteropathy associated
T-cell

Lymphoma and extraintestinal

lymphoma
2. 
Malignancy Oropharyngeal and esophageal
adenocarcinoma 
Cancers of small all and large
intestine hepatobiliary system and
pancreas
Essentials Of Diagnosis
1. Typical symptoms

abdomina
growth
Weight chronic l
retardatio
loss  diarrhoea distensio
n
n
2. Atypical  symptoms

dermatitis iron
osteoporosi
herpetiformi deficiency
s 
s  anaemia
 5.  clinical
4. abnormal
3.  Abnormal improvement
small bowel
serology test  on gluten free
biopsy result
diet
Good Luck!