its about celiac disease.

1. Celiac Disease
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2. Definition
Nowadays we are seeing a lot gluten free things like pizza, buns even dairy product.
Its due to celiac disease.
1.Celiac disease is an inherited, lifelong intolerance to gluten.
And 1 in 100 Americans are diagnosed with this.
2.It is also know as celiac sprue, or Iceberg diseases Non-tropical sprue Gluten sensitive
enteropathy(Clinically and histologically patient should respond and becomes
Normal in 6months of gluten free dietrestriction.).
If not gets better then its called Refractory diseases.
3.Can affect to any sex(malefemale)
4. proximal part of small intestine MUCOSA(mainly jejunum and
duodenum is affected).
5.Gluten is the protein found in wheat, rye and barley.
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3. ICEBERG
Classic: GI malabsorption
Atypical: any other symptoms
Silent: Asymptomatic antibodies +ve
Genetically : HLA DQ-2 & DQ-8 can confirmed.
CHIEF ANTIGEN IS GLIADIN

4. Why do people get Celiac Disease?
Genetic predisposition
Exposure to gluten (environmental trigger)
Another trigger, such as illness, stress, other autoimmune
disease
Occurs in people of all ages
Most common genetic disorder in N. America and Europe
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5. 5
Celiac Disease is:
A unique autoimmune disorder because:
◦ both the environmental trigger (gluten) and the autoantigen (tissue
Transglutaminase) are known.
◦ Antibodies of Anti-TTG and Anti- endomysial antibody(EMA), if
found confirms the serological test.
◦ elimination of the environmental trigger (gluten) leads to a
complete resolution of the disease

6. 6
Gastrointestinal Manifestations
(“Classic” or “Typical”)
Most common age of presentation: 6-24 months
But anyone with these symptoms should be screened
Chronic or recurrent diarrhea
Abdominal distension
Anorexia
Failure to thrive or weight loss
• Abdominal pain
• Vomiting
• Constipation
• Irritability

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Classic Celiac Disease

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What if patient is atypical, what are the signs?
Dermatitis Herpetiformis
Dental enamel hypoplasia
Osteopenia/Osteoporosis
Short Stature
Delayed Puberty/Infertility
Peripheral Neuropathy/Ataxia
Chronic Fatigue
Normal weight or overweight
HYPOSPLEENISM & RAISED LFT
• Iron-deficient anemia
resistant to oral Fe
• Hepatitis
• Arthritis
• Epilepsy with occipital
calcifications
• Behavioral with depression, poor
school performance, irritability
Most common age of presentation: older child to adult

9. Does celiac cause elevated liver enzymes?
Elevated liver enzymes are one of the extra-intestinal signs of celiac disease, so
patients with elevated liver enzymes should be tested for it. If the enzyme increase was
caused by celiac disease it should return to normal after following a strict gluten-free
diet.

10. 10
Silent or Asymptomatic
• Treatment with a gluten-free diet is recommended for
asymptomatic children and adults with proven intestinal
changes of Celiac Disease.
• It is most commonly diagnosed in those who also have:
– Type 1 diabetes
– Selective IgA deficiency
– Down syndrome
– Turner syndrome
– Williams syndrome
– Autoimmune thyroiditis
– A first degree relative with
Celiac Disease

11. DIAGNOSIS:
SEROLOGY + BIOPSY
SEROLOGY;
1) ANTI-GLIADIN AB: IG-A & IG-G (INVLOVED) BUT POOR SENITIVE AND SPECIFICITY.
2) ANTI-TTG AB : IG-A (INVLOVED) TISSUE TRANS GLUTAMINASE
3)ANTI-ENDOMYSIAL AB : IG-A . (VERY EXPENSIVE)
ANTI-TTG IS MOST SENSITIVE.
ANTI-EMA IS MOST SPECIFIC.

12. BIOPSY FINDINGS
1) VILLOUS ATROPHY.
2)FINDINGS LOCALIZED TO MUCOSA.
3)CRYPT HYPERPLASISA
4)MUCOSAL THICKNESS NORMAL
5)LAMINA PROPRIA INFILTRATES

13. What can patient eat?
Rice
Corn
Maize
Potato
Soyabean
Steroids in refractory celiac diseases.

14. Treatment:
AVOID GLUTEN FOOD ITEMS LIKE WHEAT ,BARLEY,RYE,OATS.

15. DANGER?
•ENTEROPATHY ASSOCIATED T-CELL LYMPHOMA
•SMALL INTESTINAL ADENOCARCINOMA
•ESOPHAGEAL SQUAMOUS CELL CARCINOMA