GLUTEN SENSITIVITY

CLINICAL IMMUNOLOGY
 Gluten-sensitive Enteropathy
(Celiac Disease or Celiac Sprue )
• gluten-sensitive enteropathy is a digestive and
autoimmune disorder that results in damage to the lining
of the small intestine when foods with gluten are eaten.

• The damage to the intestine makes it hard for the body to

absorb nutrients, especially fat, calcium, iron, and folate
Celiac disease is an autoimmune disorder that
occurs in genetically susceptible individuals.

It is triggered by a well-identified environmental

factor (gluten and related prolamin present in
wheat ‫ ﻗﻣﺢ‬rye ‫ ذرة‬, and barley‫ﺷﻌﯾر‬.
Causes of Celiac Disease
When people with celiac disease eat foods containing gluten,
their immune system forms antibodies to gluten which then
attack the intestinal lining.
This causes inflammation in the intestines and damages the
villi, the hair-like structures on the lining of the small
intestine.
• If the villi are damaged, the person cannot absorb
nutrients properly and ends up malnourished ‫ﺳوء‬
‫اﻟﺗﻐذﯾﺔ‬
• no matter how much he or she eats.
Possible presentations of celiac disease are
recognized, as follows:
 Diagnosis
• serologic tests for celiac disease
1.Anti tissue transglutaminase IgA (tTg-IgA) test
• The IgA tTG antibody level was elevated at greater than 250 U/mL
(normal level is < 15 U/mL)
2.Anti gliadin peptide antibodies IgA or IgG
may be used in some people with suspected celiac disease who are
negative for anti-tTG, especially children younger than 2 years old.
3. Anti-endomysial antibodies (EMA) -— antibodies developed in
reaction to the ongoing damage to the intestinal lining
Biopsy samples are obtained by endoscopy

• Duodenal mucosa histology

characterized by a progressive
deterioration of the villous
architecture associated with a
progressive increase in crypt
length and density.
 Multiple biopsy samples (at least 4) are
recommended because celiac disease may be
patchy and areas of villous atrophy may be
adjacent to normal areas.
 biopsy from the duodenal bulb is also
recommended, as about 2-3% of celiac children
may have changes only in that part of the
duodenum
Clinical Immunology
 Pernicious Anemia
It is an autoimmune-mediated chronic atrophic gastritis
caused by a lack of intrinsic factor .
In pernicious anemia, the body can't make enough healthy
red blood cells because it doesn't have enough vitamin B12.
 Lack Of Intrinsic Factor
• In pernicious anemia, the body makes antibodies that attack and
destroy the parietal cells. These cells line the stomach and make
intrinsic factor.
• As a result of this attack, the stomach stops making intrinsic factor.
Without intrinsic factor, the body can't move vitamin B12 through the
small intestine, where it's absorbed. This leads to vitamin B12
deficiency.
Diagnostic Tests
 Bone Marrow Tests

• For aspiration, a small amount of fluid bone marrow

through a needle is removed.
• or a biopsy, a small amount of bone marrow tissue
through a larger needle is removed. The samples are then
examined under a microscope.

In pernicious anemia, the bone marrow cells that turn into
blood cells are larger than normal.
ANY QUESTIONS
ANY QUESTIONS
Celiac disease is an immune-mediated response
to

A. Fat.
B. Carbohydrate
C. Protein
D. Gluten
Of the following, the single most important
risk factor for celiac disease is
A. Age
B. Gender
C. Race
D. Having a first – degree relative with thee
disease
Which of the following antibodies commonly appear
in patients with celiac disease?

A. Anti tissue transglutaminase IgA (tTg-IgA)

B. Anti gliadin peptide antibodies IgA or IgG

C. Anti-endomysia antibodies (EMA)

D. All of the above

Which technique is considered the criterion standard to
confirm the diagnosis of celiac disease?

A. Chest x-ray
B. Serum antibody assay
C. duodenal biopsy
D. None of the above
Which of the following statements about the diagnosis
of celiac disease is true?

A. Repeat biopsy is unnecessary.

B. There are no contraindications for the use of duodenal
endoscopy
C. Serology has been shown to be superior for diagnosis of
celiac disease.
D. The histologic lesions characteristic of celiac disease may
sometimes be missed
 In pernicious anemia, intrinsic factor is secreted by the
_______ cells which are found in the gastric mucosa.

• A. Visceral
• Langerhans
• C. Parietal
• D. Chief
The intrinsic factor is required for the absorption of

A. Iron

B. Zinc

C. Vitamin B12

D. Magnesium
The best and earliest hematological finding in
megaloblastic anemia is

A. Decreased hematocrit
B. Hyper segmented neutrophils
C. Decreased hemoglobin
D. Poikilocytosis
•
The following does not cause vitamin b12
deficiency

Ileal resection

Pernicious anemia

Fish tapeworm infestation

Colectomy