A 30-year-old male presented with general tiredness, breathlessness, weight loss, and diarrhea. Examination showed pallor and apthous ulcers. Endoscopy revealed scalloping of duodenal folds. The patient was diagnosed with celiac disease, an autoimmune disorder caused by gluten sensitivity. Celiac disease is treated through strict lifelong adherence to a gluten-free diet, though medication does not yet exist to prevent intestinal damage from gluten. Monitoring for dietary compliance and resolution of symptoms is important through follow-up testing and management of nutritional deficiencies.

1. DR.BANU CHANDER PANDIAN .S
DNB FAMILY MEDICINE
KG HOSPITAL

2. • 30 yrs Male patient presented with complaints
of generalised tiredness ,breatlessness on
exertion ,loss of weight ,diarrhea
• On examination
• Patient is thin built ,apthous ulcer present
• Pallor present
• No odema ,cyanosis,icterus,lympadenopathy

3. • Investigations
???????

4. PROVISONAL DIAGNOSIS

5. IRON DEFICIENCY ANEMIA

6. FOLLOW UP

7. WANT TO DO NEXT ????

8. Endoscopy
Endoscopic still of duodenum of patient showing scalloping of folds.

10. FINAL DIAGNOSIS

11. Celiac Disease

12. • Celiac disease is an autoimmune disorder of
the small intestine that occurs in genetically
predisposed people of all ages from middle
infancy.
• Celiac disease is caused by a reaction to
gliadin, a gluten protein found in wheat, rye
and barley

13. SYMPTOMS
• diarrhea
• weight loss
• abdominal pain
• chronic fatigue
• weakness
• malnutrition
• In children
– failure to thrive
– irritability
– diarrhea and bloating
• osteoporosis
• arthritis and joint pain
• anemia
• infertility
• frequent miscarriage
• chronic fatigue
syndrome
• depression
• behavioral changes

14. Celiac disease as a multiorgan autoimmune disease
General:
Puberty & growth
delay
Malignancies
Anemia
GI system:
Diarrhea, vomiting
Distension, pain
Malnutrition,
weight loss
Hepatitis,
cholangitis
Bone:
Osteoporosis,
fractures
Arthritis
Dental anomalies
Skin & mucosa:
Dermatitis
herpetiformis
Aphtous
stomatitis
Hair loss
Heart:
Carditis
CNS:
Ataxia, seizures
Depression
Reproductive
system:
Miscarriage
Infertility

15. Pathogenesis:
Genetic
predisposition
HLA-DQ(DQ2
&/or DQ8) genes
Environmental
trigger
 Dietary

17. Diagnosis: Serology
 Serum IgA endomysial antibodies (EMA) &
 serum IgA tissue transglutaminase (tTG) antibodies have both sensitivity &
specificity > 95%.
 Testing for gliadin antibodies is no longer recommended because of its low
sensitivity & specificity for celiac disease.

18. 18
Normal small bowel Celiac disease
Gluten
Gluten-free diet

19. • The classic pathology changes of celiac disease in the
small bowel are categorized by the "Marsh
classification"
Marsh stage 0: normal mucosa
Marsh stage 1: increased number of intra-epithelial lymphocytes,
usually exceeding 20 per 100 enterocytes
Marsh stage 2: proliferation of the crypts of Lieberkuhn
Marsh stage 3: partial or complete villous atrophy
Marsh stage 4: hypoplasia of the small bowel architecture

20. MARSH Staging

21. Evaluation of Celiac Disease

22. Dietary Management in Celiac Disease
At present, the only effective treatment is a life-
long gluten-free diet (GFD).
No medication exists that will prevent damage or prevent
the body from attacking the gut when gluten is present.
Strict adherence to the diet allows the intestines to heal,
leading to resolution of all symptoms in most cases and,
depending on how soon the diet is begun, can also
eliminate the increased risk of complications.

23. Treatment:
THE GLUTEN FREE DIET CAN BE LOW IN
• High protein
• High calorie
• High Iron , folic acid, vit B12 , A, K, and D as water
soluble B vitamins (thiamine, riboflavin, niacin, folate)
• Calcium
• Zinc
• Magnesium
• Fiber

24. Follow-Up:
Serologic markers (serum IgA tTG) used to monitor compliance with
GFD.
Antibody levels return to normal within 3-12 months of starting a
GFD but may take up to 30 months if the initial titers are high.
Repetition of small bowel biopsy 3-4 months after initiation of a
GFD is not necessary if the patient responds appropriately to
therapy.
If the patient does not respond as expected → revise the patient’s
adherence to GFD, then the physician should consider other
differential diagnosis.

25. Thank You