ALL STEM CELLS

Celiac disease (gluten-sensitive enteropathy, previously celiac sprue, nontropical sprue) is one of the most commonly undiagnosed disorders. It occurs in up to 1% of the population of most countries.
Celiac disease is an autoimmune intestinal disorder in which there is an altered gut mucosal response to dietary gluten, which is in wheat, barley, malt, and rye, resulting in small bowel villous atrophy and crypt hypertrophy with resulting malabsorption. It can cause growth retardation in children and is associated with HLA-DQ2 and HLA-DQ8. It may go into remission during adolescence, and then recur. If detected early, the patient may have only mild symptoms such as bloating and loose stools.

Extraintestinal manifestations

• Iron deficiency anemia (most common presentation; iron is absorbed mostly in the duodenum): low Hgb, MCV, and ferritin
• Abnormal serum aminotransferases
• Dem1atitis herpetiformis-discussed below
• Osteoporosis
• Osteomalacia
• Neuropsychiatric symptoms
• Dental enamel defects
Primary intestinal lymphoma is a rare, late complication of celiac disease.

Deficiencies causes

• Iron
• Folic acid
• Calcium
• Vitamin D
• Vitamin B12 (rarely)
• Vitamin K
There is a wide spectrum of presentations. Patients often have little or no GI symptoms and may present with only a psychiatric disorder, osteomalacia, or a purulent pustular rash.
Dermatitis herpetiformis is a manifestation of celiac disease. It is characterized by intensely itchy vesiculopapular eruptions on the face, trunk, buttocks, sacrum, and extensor surfaces of elbows and knees.

Most patients with dermatitis herpetiformis do not have abdominal symptoms, although 85% have the characteristic findings on intestinal wall biopsy.

Diagnosis

(1) Evidence of malabsorption (steatorrhea, weight loss, iron deficiency anemia)
(2) Many patients with latent celiac disease may have only a positive tissue transglutaminase antibody test (90+% sensitivity) or positive antiendomysial antibody test
(3) A positive response to a gluten-free diet (clinical, chemical, histological, and immunologic)
(4) Abnormal small bowel biopsy to clinch the diagnosis

The best antibody tests are:
• Tissue transglutaminase (tTG) antibody
• lgA antiendomysial Ab (but not good with lgA deficiency)

Celiac disease patients need gluten restriction for lifetime.(gluten-free diet:GFD)