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Difference between revisions of "Celiac sprue"
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*Biopsy should consist of 2-3 sites. In children it is important to sample the duodenal cap, as it is the only affected site in ~10% of cases. | *Biopsy should consist of 2-3 sites. In children it is important to sample the duodenal cap, as it is the only affected site in ~10% of cases. | ||
== | ===General=== | ||
{{ | ====Etiology==== | ||
* | *Autoimmune. | ||
** | |||
** | ====Epidemiology==== | ||
* | *Associated with: | ||
** | **The skin condition ''[[dermatitis herpetiformis]]''.<ref>TN 2007 D22</ref> | ||
***Tx: dapsone. | |||
**IgA deficiency - 10-15X more common in celiac disease vs. healthy controls.<ref name=pmid12414763>{{Cite journal | last1 = Kumar | first1 = V. | last2 = Jarzabek-Chorzelska | first2 = M. | last3 = Sulej | first3 = J. | last4 = Karnewska | first4 = K. | last5 = Farrell | first5 = T. | last6 = Jablonska | first6 = S. | title = Celiac disease and immunoglobulin a deficiency: how effective are the serological methods of diagnosis? | journal = Clin Diagn Lab Immunol | volume = 9 | issue = 6 | pages = 1295-300 | month = Nov | year = 2002 | doi = | PMID = 12414763 }}</ref> | |||
**Risk factor for ''gastrointestinal T cell lymphoma'' - known as: ''enteropathy-associated T cell lymphoma'' (EATL). | |||
====Treatment==== | |||
*Gluten free diet. | |||
**''Mnemonic'': BROW = barley, rye, oats, wheat. | |||
====Serologic testing==== | |||
*Anti-transglutaminase antibody. | |||
**Alternative test: anti-endomysial antibody. | |||
*IgA -- assoc. with celiac sprue. | |||
===Microscopic=== | |||
Features:<ref name=Ref_PBoD843>{{Ref PBoD|843}}</ref> | |||
*Enteritis. | |||
**Intraepithelial lymphocytes - '''key feature'''. | |||
**Plasma cells. | |||
**Macrophages. | |||
*Loss of villi - '''important feature'''. | |||
**Normal duodenal biopsy should have 3 good villi. | |||
*Mitosis increased (in the crypts). | |||
Image: | |||
*[http://commons.wikimedia.org/wiki/File:Coeliac_path.jpg Celiac sprue (WC)]. | |||
Notes: | |||
*If you see acute inflammatory cells, i.e. neutrophils, consider Giardiasis and other infectious etiologies. | |||
*Biopsy should consist of 2-3 sites. In children it is important to sample the duodenal cap, as it is the only affected site in ~10% of cases. | |||
===Grading=== | ===Grading=== | ||
| Line 68: | Line 97: | ||
| Flattened mucosa | | Flattened mucosa | ||
|} | |} | ||
==DDx== | |||
*Giardiasis. | |||
**Have giarrdia organisms. | |||
**Always consider ''Giardiasis'' and especially on exams. | |||
*Whipple's disease (very rare). | |||
**Abundant macrophages should make one suspicious. | |||
==See also== | ==See also== | ||