Celiac Disease

Primary Histology:
-Mucosal Inflammation
-Villous Atrophy
-Crypt Hyperplasia

Primary Symptoms:
unexplained continued
-diarrhea with
-foul smelling floating stools d/t steatorrhea.
-malabsorption
-weight loss
-bloating

or with unexplained
-iron def. anemia
-folate (B9) def.
-B12 def.
-elevated aminotransferases

Diff Dx: lactose intolerance, IBS
Dx: Primarily the symptoms, be sure to test IgA anti-TTG (tissue transglutaminase)
Then upper endoscopy with small bowel bx. Also IgA EMA (endomysial antibody), IgA/IgG anti-TTG and IgA/IgG DGA (deaminated gliadin antibody).
Tx: Remove Gluten from diet

Diff Dx:
Whipple's Disease: periodic PAS Acid-Schiff positive macrophages in the duodenum, with dementia, AMS, apathy, myoclonus, cranial nerve involvement. ID of Topherema whipplei by DNA PCR. IgA tests above should be negative.

Tropical sprue: poorly understood etiology. Lipid and folate malabsorption common on chronic diarrhea. More eosinophils compared with celiac disease.

Crohn's Disease: IgA tests above should be negative. p-ANCA is highly specific for Crohn's and distinguishes from Ulcerative Colitis, the other kind of Inflammatory Bowel Disease.