Review Question - QID 101134

Celiac disease is a chronic, hereditary, autoimmune intestinal malabsorption disorder caused by intolerance to gluten. It is associated with other autoimmune diseases such as Hashimoto's thyroiditis and diabetes mellitus type I.

Celiac disease commonly occurs in women in their third decade. Patients present with diarrhea, weight loss, pallor, and abdominal discomfort. Celiac disease is frequently associated with dermatitis herpetiformis, a papulovesicular rash on extensor surfaces. Treatment focuses on removing gluten from the patient’s diet. Some refractory cases are treated with steroids.

Presutti et al. review celiac disease. Up to one in every 100-200 people in the US has celiac disease. Manifestations vary from absent symptoms to overt malabsorption with multiple organ system involvement. The initial test in the workup of celiac disease is a test for serum immunoglobulin A tissue transglutaminase antibodies.

Daher et al. discuss the relationship between thyroid disease and the digestive tract. Hashimoto's thyroiditis and Grave's disease are most frequently associated with celiac sprue and primary biliary cirrhosis. The mechanism explaining this relationship is not yet known.

Figure A is a duodenal biopsy showing pathognomonoic blunting of intestinal villi, lengthening of intestinal crypts, hyperplastic glands, and inflammatory infiltrate of the lamina propria. All are characteristic of Celiac disease.

Incorrect Answers:
Answer 1: Zollinger-Ellison syndrome involves increased levels of gastrin that lead to excess gastric acid secretion and duodenal ulceration. It is not associated with Celiac disease.
Answer 2: Hirschsprung’s disease can be congenital or acquired and involves the absence or destruction of ganglionic cells, leading to constant bowel obstruction. It is not associated with Celiac disease.
Answer 3: Peutz-Jeghers polyposis is an autosomal dominant disorder marked by hamartomatous polyps in the small bowel. It is not associated with Celiac disease.
Answer 5: H. pylori infection causes gastric and duodenal ulceration. It is not associated with celiac disease.