Celiac Disease - VCU Internal Medicine Electronic Residency ...

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Diagnosis - Serology Anti-Endomysial (EMA) IgG helpful if IgA deficient sensitivity ~40% specificity > 95% not offered by Promethius labs Antihuman-TissueTransglutaminase (tTG) IgG sensitivity ~40% specificity >95% not offered by Promethius lab Total Serum IgA cost $25
Diagnosis – Intestinal Biopsy • Biopsy 2 nd or 3 rd portion of duodenum • Multiple biopsies should be obtained since disease may be patchy • Histologic features: villous atrophy, crypt hyperplasia , increased intraepithelial and lamina propria lymphocyte count, dissarray of enterocytes. • Some of these features can be seen in giardiasis, , milk intolerance, tropical sprue, marasmus, , GVHR • Graded on Marsh scale (0-4). • Some degree of villous atrophy (Marsh type 3) is necessary to confirm diagnosis • May require several pathologists to review slides
Page 1 and 2: Chief’s s Conference John Port, M
Page 3 and 4: Celiac Disease - Background • Pre
Page 5 and 6: Celiac Disease - Subphenotypes Sile
Page 7 and 8: Associated Conditions Dermatologic
Page 9 and 10: Associated Conditions (cont’d) He
Page 11 and 12: Alopecia Areata
Page 13 and 14: Associated Conditions (cont’d) Rh
Page 15 and 16: Who should be screen for CD Green a
Page 17 and 18: Diagnosis - Serology • Sensitivit
Page 19: Diagnosis - Serology Anti-Gliadin (
Page 23 and 24: Diagnosis - HLA Typing HLA DQ2 or D
Page 25 and 26: Completing the Diagnosis • Trial
Page 27: CELIAC DISEASE A Lifetime Without B

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