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Key Points
• Gluten Sensitive Enteropathy• Malabsorption, extra-GI effects• Dx w/: serology, biopsy, gluten restriction• Consider with: DM1, Fe-deficient, infertile,
bad osteoporosis, IBS, autoimmune thyroid disease, chronic GI Sx
• MAKE the diagnosis prior to lifetime gluten restriction!
Dermatitis Herpetiformis
• THE physical exam finding• Itchy, vesiculo-bullous rash of extensors, trunk,
intrascapular region
Often treated with dapsone only, but gluten should be removed from diet
Associations
• DM type 1• Autoimmune thyroid disease• Down syndrome• Selective IgA deficiency• Infertility• Atrophic glossitis• Iron deficiency• Metabolic bone disease – early/severe osteoporosis• CNS: peripheral neuropathy, cerebellar disease, ?
anxiety/depression
Serology – how good is it?
• As good as the diet: if avoiding gluten, titers drop false negatives!
• Best = IgA tissue transglutaminatse or IgA endomysial Ab. o EMA: LR+33; LR- 0.02o tTG: LR+ = 15.8; LR- = 0.05 o Gliadin Ab LR+ = 4; LR- = 0.25
• Antigliadin Ab test: not as Sn/Sp; avoid• Almost all w/ 1) positive serology or 2) those with negative
serology but strong suspicion should have small bowel biopsy• If still negative: IgA deficient? – check IgG tests, avoiding gluten
already?, return to DDx.