Gastroenterology
Celiac Disease
셀리악병
Immune-mediated small bowel injury triggered by gluten (gliadin)
- How common
- ~1% of population
- Typical age
- All ages
What is it?
In HLA-DQ2/DQ8+ individuals, gliadin is modified by tissue transglutaminase, triggering autoantibodies and T-cell mediated villous atrophy.
Commonly affected: Proximal small bowel (duodenum, jejunum)
How it develops
- HLA-DQ2/DQ8 + glutenGenetic predisposition + dietary trigger
- Gliadin deamidationTissue transglutaminase (tTG) modifies gliadin
- Immune activationCD4 T cells and autoantibodies generated
- Villous atrophyReduced absorptive surface → malabsorption
Symptoms
- Chronic diarrhea/steatorrheaFrothy, foul-smelling
- Iron deficiency anemiaProximal malabsorption
- Weight loss/growth failureResult of malabsorption
- Bloating/painPostprandial worse
- Dermatitis herpetiformisPruritic vesicular rash (elbows/knees)
How it is examined
- SerologyIgA tTG, IgA endomysial antibodies
- Check IgA deficiency5% of celiacs have IgA deficiency
- Duodenal biopsy on glutenDone while on gluten; Marsh classification
Imaging
Imaging adjunctive; SBFT shows proximal dilation, mucosal changes.
- Bowel dilatation
- Mucosal changes
EGD + duodenal biopsy is gold standard.
- Scalloped folds
- Flat/atrophic mucosa
- Marsh 3 villous atrophy
Non-surgical care
- Lifelong gluten-free dietComplete elimination of wheat, barley, rye
- Dietitian consultReplace micronutrient deficiencies
- Micronutrient supplementationIron, folate, B12, vitamin D, calcium
- Screen associated conditionsThyroid, T1DM, bone density
- Follow-up testingAntibody titers at 6mo and 1yr; confirm recovery
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Refractory or complications (EATL lymphoma)
Procedures that may be discussed
- Steroids/immunosuppressants
- Refractory celiac II → lymphoma evaluation
Outlook
Strict GFD restores mucosa in 6-24 mo; non-adherence risks lymphoma, osteoporosis.