Celiac disease is an immune-mediated, multisystem disorder that affects genetically susceptible individuals who are exposed to gluten-containing grains such as wheat, barley, and rye. Also known as gluten-sensitive enteropathy, Celiac disease is a condition in which the body responds to gluten with an inappropriate immune response causing small intestinal inflammation and damage. CD can be associated with different autoimmune and idiopathic diseases, including type 1 diabetes mellitus, Hashimoto’s thyroiditis, selective IgA deficiency, alopecia areata, Addison’s disease, connective tissue diseases (mainly Sjogren’s syndrome), chromosomal diseases (Down, Turner, and William’s syndromes), neurological diseases (cerebellar ataxia, peripheral neuropathy, epilepsy with and without occipital calcifications), hepatic autoimmune diseases (primary biliary cholangitis, autoimmune hepatitis, primary sclerosing cholangitis), and idiopathic dilated cardiomyopathy. Dermatitis herpetiformis is an extraintestinal manifestation that is pathognomonic for celiac disease. Because the rash is an immunologic response to gluten, it is sometimes referred to as celiac disease of the skin. This papulovesicular rash is extremely pruritic and found on extensor surfaces, such as the elbows, knees, buttocks, and scalp. The two antibodies measured are anti-tissue transglutaminase antibodies (by enzyme-linked immunosorbent assay or ELISA measured numerically) and anti-endomysial antibodies. Esophagogastroduodenoscopy with small bowel biopsy is recommended to confirm the diagnosis in most patients, including those with a negative serologic test for whom clinical suspicion of celiac disease persists. Genetic testing for human leukocyte antigen alleles DQ2 or DQ8 may be performed in select cases. A gluten-free diet for life is the primary treatment Satyendra Dhar, MD, @DharSaty #celiac #disease #gluten #dermatitis #herpetiformis #gliadin #diagnosis
