Celiac disease

(JAMA 2017;318:647; Lancet 2018;391:70; Gastro 2019;156:4)

Immune rxn in genetically predisposed Pts (~1% pop) to gliadin, a component of gluten (wheat protein) → small bowel inflammatory infiltrate → impaired absorption

Other s/s: Fe/folate/B12 defic anemia; osteoporosis; dermatitis herpetiformis; ↑ ALT/AST

Dx: best if eating gluten when tested; IgA anti-tissue transglutaminase Ab (most Se), IgA anti-deaminated gliadin peptide Ab; IgA α-endomysial Ab. Duodenal bx confirms dx (blunted villi, crypt hyperplasia, inflamm infiltrate); absence of HLA-DQ2/8 excludes dx.

Rx: gluten-free diet; 7–30% do not respond to diet → ? wrong dx or noncompliant

Complic: ~5% refractory sx, risk of T-cell lymphoma and small bowel adenocarcinoma