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Small Bowel· Chapter 10

Celiac Disease and Sprue Spectrum

TTG-IgA plus DGP serology, Marsh and Oslo classifications, gluten-free diet with mucosal healing as the goal, dermatitis herpetiformis, refractory celiac type 1 versus type 2, the EATL pathway, and the seronegative villous-atrophy differential (NSAID enteropathy, olmesartan, autoimmune enteropathy).

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28 MCQs2 podcast episodes
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What this chapter covers

  • Section 10.1: Pathogenesis, genetics, and epidemiology

    Celiac disease is an HLA-restricted, gluten-driven enteropathy, and every fact in the chapter falls out of a single mechanistic sentence: gluten peptides resist gastrointestinal proteolysis, reach the lamina propria, are deamidated by tissue transglutaminase 2, and the deamidated peptides bind HLA-DQ2 or HLA-DQ8 on antigen-presenting cells where they activate gluten-specific CD4+ T cells that drive the cytokine cascade behind the villous atrophy.

  • Section 10.2: Clinical presentations

    Modern celiac disease in adults rarely looks like the textbook malabsorption picture, and the boards have moved with the literature.

  • Section 10.3: Diagnosis

    Diagnosis of celiac disease is anchored on serology drawn on a gluten-containing diet, confirmed by upper endoscopy with multiple duodenal biopsies, and triangulated against HLA in selected scenarios.

  • Section 10.4: Treatment, monitoring, and mucosal healing

    A strict, lifelong gluten-free diet is the entire treatment for celiac disease, and every other element of management is built around supporting and verifying that diet.

  • Section 10.5: Refractory celiac disease

    Refractory celiac disease is the diagnosis the candidate must consider when a patient with biopsy-proven celiac disease has persistent or recurrent malabsorptive symptoms with histologic villous atrophy despite at least 12 months of strict gluten-free diet and no other explanation.

  • Section 10.6: Complications

    The malignancy spectrum in celiac disease is the high-stakes downstream consequence the boards expect candidates to know, and the central fact is that risk is concentrated in patients with refractory disease (especially RCD2) and in patients with poorly controlled or unrecognized disease, while strict gluten-free diet attenuates but does not eliminate the risk.

Podcast episodes

  1. 01

    Celiac Diagnosis and Treatment

    This episode covers celiac from mechanism through monitoring, and every fact in the chapter falls out of the mechanism, so start there. Gluten peptides resist digestion because of their proline-rich structure, so they reach the lamina propria intact through a leaky barrier.

  2. 02

    Refractory Celiac and Complications

    This episode covers refractory celiac and the complications: the two types of refractory disease and the malignancies that follow. Start with the picture the boards keep returning to.