celiac disease

HLA?

DQ2 AND DQ8

PATHOPHYSIO

Gluten intake → deaminated by tissue trangglutaminase → incr gliadin → anti tTG → IL-1, INF gumma, TNF alpha → inflam → CD4 →… → villous atrophy, crypt hyperplasia, dec enterocyte height, and intraepithelial lymphocytes infiltration

Classical vs non classical

Refractory form

Persistent Villous atrophy after y of gluten free diet

Class 1 → no intraepith lymphoc infiltrate

Class 2 → intraepith lymphocyte

Who should be tested ?

DM

Sjogren

Down syndrome

PBC

Thyroid diseaases

Sarcoidosis

Complications if untreated

-small bowel adenocarcinoma

-jejuno ileitis ulcerative

-non hodgkin lymphoma

-osteoporosis

-eneteropathy associated T cell lymohoma

-reproductive disordeers

Endoscopic findings

-mosaic pattern

-,mucosal fold scalloping

-reduced mucosal folds

Serological tests

Decr in

Ca, Mg, alumin. Total protein, vit D, iron, folate, bone density, hyposplenisim…

Treatment timing improv

Imrov w/in few weeks

Villous atrophy impro w/in 1-2y

What about oats?

May be reintroduced safely in most patients after 6-12 m

May be associated with what disease?

Lactase def 2ry to damage of surface epithelial cells

Refractory celiac treatments

Cortico and immunsup ( azathioprine and cyclosporins)

Chemotherapy as anti T cells ( clardibine and pentostatine)

Future treatments of CELIAC

-Rho/ Rho kinase inhibots

-gluten entry across intestinal epithelium blockers

-modified glutens

-immunotherapy

-vaccines

-gluten degrading enzyme

Dermatitis herpetiformis

Crops of intensely itchy blisters

Over knees, elbows and buttocks

Linear or granular IgA depo in dermo - epideermal junction

Associated with villous atrophy

Treated with gluten free diet +- dapsone