GASTROENTEROLOGY ARTICLE OF THE WEEK
January 10, 2008
Green PHR, Cellier C. Celiac disease. N Engl J Med 2007;357:1731-43.
1. Tissue transglutaminase (TTG) is:
a. a toxic by-product of gliadin digestion
b. a toxic by-product of gluten digestion
c. an enzyme that deaminates gliadin and increases the immunogenicity
d. only present in patients with celiac disease
2. Events that increase or decrease the chances of developing celiac disease include
a. introducing gluten before 4 months of age is protective
b. breast-feeding is protective
c. rotavirus infections increases risk
d. overlapping gluten with breast feeding is protective
e. introducing gluten after 7 months markedly decreases risk
3. Conditions associated with celiac sprue include
a. Turner’s syndrome
b. Down’s syndrome
c. type 2 diabetes
d. primary biliary cirrhosis
e. type 1 diabetes
4. Which of the following tests, if normal or negative, excludes the diagnosis of celiac disease on a patient who is following a strict gluten-free diet?
a. small bowel biopsy
b. anti TTG- IgG antibodies
c. anti TTG-IgA antibodies
d. HLA DQ2 and DQ8
e. IgA anti-endomysial antibody
f. anti-gliadin antibodies IgG and IgA
True or False
5. The anti-endomysial antibody reacts against the same antigen as the TTG-antibody.
6. Normal individuals are unable to digest or absorb gliadin
7. CD4+ T cells that recognize gliadin peptides are bound to HLA DQ2 or DQ8, thus, a person who is negative for DQ2 or DQ8 cannot develop celiac disease
8. Persons with celiac disease are at increased risk of autoimmune disorders
9. Measurable anti-TTG antibodies 1 year after initiation of a gluten free diet strongly suggests non-compliance.
10. When typical changes are present, a small bowel biopsy is diagnostic for celiac disease
11. The titer of anti-TTG and anti-endomysial antibodies increases with the degree of mucosal damage
12. Refractory celiac disease associated with a CD3+, CD8- intraephitelial cell phenotype has an increased risk of progression to ulcerative jejunoileitis and T-cell lymphoma.
13. Celiac disease patients have an increased risk of breast cancer.
14. Non-adherence to diet is the most common cause of refractory celiac disease
15. An asymptomatic person who tests positive for HLA DQ 2 and 8 is likely to have celiac disease
16. A person with iron deficiency anemia and a negative IgA-TTG test does not need to have small bowel biopsies done to exclude celiac disease
17. Adenocarcinoma of the jejunum is more common in celiac disease patients and usually starts as a polypoid adenoma