Our topic now brings us to Celiac Sprue.
Now, Celiac Sprue is extremely marketable
in terms of the products that we find everywhere in the US.
You´re going to the grocery store, gluten-free diet or gluten-free products.
You walk into a pizzaria, there´s gluten-free crusts.
So, obviously here we have an issue where the body
is then creating an autoimmune type of status in which now,
anywhere along the GI tract, you might have destruction taking place.
Welcome to Celiac disease.
In the US the prevalence is as high as 1 in 200.
Diarrhea is not the main symptom in adult. Doesn´t have to be.
Iron deficiency is much more common.
Remember that Celiac Sprue, you should be thinking about
being in the intestine where the lesion is taking place
and it can pick and choose us to whatever it wants
in terms of what it wants to destroy.
It doesn´t have to be continuous. Maybe it´s destroying the duodenum.
Maybe it might skip over down to the jejunum
or maybe perhaps even down to terminal ileum resulting in B12 deficiency.
So malabsorption is a big issue in Celiac.
Once you start destroying the parts of the intestine everywhere,
at some point in time, there is some kind of malabsorption for sure taking place
maybe perhaps even vitamin D and therefore resulting to osteomalacia in your patient.
Associated with, apart from the intestine
and diarrhea that might be associated in malabsorption
on the skin there´s an extra intestinal manifestation, it looks like herpes but it´s not.
We call this dermatitis herpetiformis which you would expect upon biopsy here
would be immunoglobulin A and only reason for that is because,
remember, the type of immunoglobulin that you have in your GI system is IgA.
The increased incidence of small bowel lymphomas and juvenile diabetes mellitus.
Other autoimmune conditions could also be associated with Celiac Sprue.
Here is the skin manifestation that looks like herpes but it´s not.
This is a patient that is suffering from Celiac disease.
Now, we go ahead and call this dermatitis herpetiformis.
Do not forget this and do not choose anything.
Make sure that you pay attention to the proper histories.
So if there´s a history in the patient of may be consuming wheat and bread
and such and apart from having malabsorption syndrome,
have issues in the skin, this is Celiac.
Diagnosis: We´re looking for what´s known as tissue transglutaminase,
anti-endomysial, anti-gliadin antibodies. I would know all three.
You need to know all three. Transglutaminase, anti-endomysial
and gliadin antibodies for diagnosis. What then happens to the intestine?
Remember, if by chance it´s the duodenum that´s being affected
which normally should have all of that finger-like villi,
it gets blunted and when it becomes blunted, then you worry about malabsorption.
How do you manage a patient with Celiac?
Well, if you know that the patient is most likely having exacerbations
after consumption of these food products that contain gluten.
Well, obviously gluten-free diet becomes highly recommended.
Relapses usually either dietary non-compliance or cross-contamination
and as we mention earlier whenever you have an autoimmune disease,
and I mean anywhere in the body including Hashimoto,
including autoimmune disease with pernicious anemia or autoimmune disease
such as celiac, lymphomas is something that you´re paying attention to.
Corticosteroids for refractory cases.
What you´re seeing here in fact with Celiac is the fact that in the duodenum,
there is absolutely no microvilli. It´s being completely blunted.
On top where we are here is the intestine and the lumen
would be on the top portion of this picture
and normally should have little finger-like villi that is responsible for reabsorption
increasing surface area. That has been lost in Celiac.