Celiac Diseae | Celiac Disease made easy

Celiac Disease. if you want to understand the topic of celiac disease, then this is best place for you. Because we teach medicine for preparation of exams. we will teach you core concepts of celiac disease...

What is Celiac Disease?

Celiac Disease is an Autoimmune-mediated intolerance of gliadin (gluten protein found in wheat) leading to malabsorption and steatorrhea.

Clinical Menifestations:


Gastrointestinal

  • Diarrhea, ± steatorrhea, weight loss
  • Abdominal pain
  • Flatulence/bloating
  • Late manifestations: ulcerative jejunitis, enteropathy-associated T-cell lymphoma

Mucocutaneous

  • Dermatitis herpetiformis
  • Atrophic glossitis

Endocrine

  • Vitamin D deficiency
  • Secondary hyperparathyroidism

Bone disorders

  • Osteomalacia/osteoporosis (adults)
  • Rickets (children)

Hematologic

  • Iron deficiency anemia

Neuropsychiatric

  • Peripheral neuropathy
  • Depression/anxiety




Association with Autoimmunity:


Patients with type 1 diabetes are at high risk of celiac disease,possibly related to multiple shared  genetic loci between 2 autoimmune conditions.  In addition to autoimmunity (eg, autoimmune thyroiditis, family history of autoimmune disease), another risk factor strongly associated with celiac disease is Down syndrome. 

D-Xylose Test:

D-xylose is a monosaccharide that can be absorbed in the proximal small intestine without degradation by pancreatic or brush border enzymes.  It is subsequently excreted in the urine.   

In the D-xylose test, the patient is given an oral dose of D-xylose, with subsequent assay of urine and venous blood.  Patients with proximal small intestinal mucosal disease (eg, celiac disease) cannot absorb the D-xylose in the intestine, and urinary and venous D-xylose levels will be low .   

By contrast, patients with malabsorption due to enzyme deficiencies (eg, chronic pancreatitis) will have normal absorption of D-xylose. 


A false-positive D-xylose test (ie, low urinary D-xylose level despite normal mucosal absorption) can be seen in the following:

  1. Impaired glomerular filtration 
  2. Delayed gastric emptying
  3. Small intestinal bacterial overgrowth (SIBO), characterized by alterations in small intestinal flora (due to abnormal intestinal anatomy or motility), leading to bacterial fermentation of the D-xylose before it can be absorbed.  SIBO is treated with rifaximin; therefore, it is unlikely in this patient whose D-xylose test results did not change following treatment with rifaximin.

Diagnosis

  • ↑ Tissue transglutaminase IgA antibody
  • Proximal intestinal biopsy (villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis)

Treatment

  • Gluten-free diet
  • Dapsone for dermatitis herpetiformis


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