{"id":4422624,"date":"2025-01-12T08:11:58","date_gmt":"2025-01-12T14:11:58","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/celiac-disease\/"},"modified":"2025-01-12T08:22:44","modified_gmt":"2025-01-12T14:22:44","slug":"celiac-disease","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/celiac-disease\/","title":{"rendered":"Celiac Disease"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">OVERVIEW oF CELIAC DISEASE<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Definition<\/strong>: Celiac disease (gluten-sensitive enteropathy, nontropical sprue) is a small bowel disorder characterized by:\n<ul class=\"wp-block-list\">\n<li>Mucosal inflammation<\/li>\n\n\n\n<li>Villous atrophy<\/li>\n\n\n\n<li>Crypt hyperplasia<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Cause<\/strong>: An immune-mediated disorder triggered by gliadin (component of gluten found in wheat, barley, and rye).<\/li>\n\n\n\n<li><strong>Prevalence<\/strong>: ~1 in 300 individuals (rarer in those of Chinese, Japanese, or African descent).<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">PATHOPHYSIOLOGY<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Genetically determined<\/strong> immune process.<\/li>\n\n\n\n<li>Gluten exposure \u2192 <strong>tissue transglutaminase (tTG) deamidates gliadin<\/strong> \u2192 enhanced immunogenicity \u2192 autoimmune reaction.<\/li>\n\n\n\n<li><strong>Key antibodies<\/strong>:\n<ul class=\"wp-block-list\">\n<li>IgA anti-endomysium<\/li>\n\n\n\n<li>IgA anti\u2013tissue transglutaminase<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Mechanism<\/strong>: Ongoing immune response damages the small intestinal villi \u2192 malabsorption.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">CLINICAL PRESENTATION<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Common malabsorption signs<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Steatorrhea (foul-smelling, floating stools)<\/li>\n\n\n\n<li>Diarrhea<\/li>\n\n\n\n<li>Weight loss<\/li>\n\n\n\n<li>Abdominal pain\/distension<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Nutrient deficiencies<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Iron deficiency anemia (microcytic)<\/li>\n\n\n\n<li>B vitamin deficiencies (e.g., vitamin B12)<\/li>\n\n\n\n<li>Vitamin D and calcium deficiency \u2192 osteopenia, osteoporosis, osteomalacia<\/li>\n\n\n\n<li>Vitamin K deficiency \u2192 easy bruising, coagulopathy<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Other manifestations<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Growth failure in children<\/li>\n\n\n\n<li>Dental enamel defects<\/li>\n\n\n\n<li>Edema (protein loss)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">ASSOCIATED CONDITIONS<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Dermatitis herpetiformis<\/strong> (itchy papulovesicular rash)<\/li>\n\n\n\n<li><strong>Type 1 diabetes<\/strong> (5% of T1D patients have celiac disease)<\/li>\n\n\n\n<li><strong>Autoimmune thyroid disease<\/strong><\/li>\n\n\n\n<li><strong>IgA deficiency<\/strong><\/li>\n\n\n\n<li><strong>Liver disease<\/strong><\/li>\n\n\n\n<li><strong>Down syndrome<\/strong> (up to 16% may have celiac disease)<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">DIAGNOSTIC EVALUATION<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Clinical suspicion<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Chronic diarrhea, malabsorption, weight loss<\/li>\n\n\n\n<li>Iron\/B12 deficiency<\/li>\n\n\n\n<li>Osteopenia\/osteoporosis<\/li>\n\n\n\n<li>Infertility, short stature, delayed puberty<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Initial tests<\/strong>:\n<ul class=\"wp-block-list\">\n<li><strong>Serology<\/strong> (on a gluten-containing diet):\n<ul class=\"wp-block-list\">\n<li>IgA tissue transglutaminase antibody (tTG-IgA)<\/li>\n\n\n\n<li>IgA endomysial antibody (EMA)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>If IgA is deficient \u2192 use IgG-based tests (tTG-IgG).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Small bowel biopsy<\/strong> (gold standard for confirmation):\n<ul class=\"wp-block-list\">\n<li>Villous atrophy<\/li>\n\n\n\n<li>Crypt hyperplasia<\/li>\n\n\n\n<li>Increased intraepithelial lymphocytes<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>72-hour stool fat<\/strong> (to document steatorrhea) is sometimes used to characterize malabsorption severity.<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">MANAGEMENT<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Gluten-free diet (lifelong)<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Eliminate wheat, rye, barley<\/li>\n\n\n\n<li>Dietitian consultation<\/li>\n\n\n\n<li>Focus on strict label reading for hidden gluten<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Supplementation<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Correct nutrient\/vitamin deficiencies (e.g., iron, vitamin B12, vitamin D, calcium, vitamin K)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Response<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Symptom improvement usually within ~2 weeks<\/li>\n\n\n\n<li>Nonresponse often linked to inadvertent dietary gluten<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>OVERVIEW oF CELIAC DISEASE PATHOPHYSIOLOGY CLINICAL PRESENTATION ASSOCIATED CONDITIONS DIAGNOSTIC EVALUATION MANAGEMENT<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[689],"class_list":["post-4422624","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-obesity-medicine","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422624","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":2,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422624\/revisions"}],"predecessor-version":[{"id":4422626,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422624\/revisions\/4422626"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422624"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422624"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}