Celiac sprue diagnosed by –
Correct Answer: Unequivocal response to gluten restriction
Description: Ans. is 'b' i.e., Unequivocal response to Gluten resriction Pattern of involvement in Celiac sprue and Tropical sprue.o Celiac sprue involves the proximal portion of small intestine as this portion is maximally exposed to the gliadin protein, this is the reason for iron deficiency anemia in Celiac disease (Iron is absorbed maximally from duodenum)o In Tropical sprue, unlike Celiac sprue, injury is seen at all levels of small intestine, patients frequently present with megaloblastic anemia. (Vit B12 and folate absorbed from distal ileum).Diagnosis of celiac sprueThe diagnosis of celiac sprue requiresi) Small intestinal biopsyii) Serological diagnosisSmall intestinal biopsy in celiac sprueo The small intestinal biopsy is characteristic but not specific.o Similar features are observed in tropical sprueThe characteristic features areo Findings are localized to the mucosa.o Overall mucosal thickness remains sameo Surface epithelium shows vacuolar degenerationo Flattening or blunting of the villio Hypertrophy of intestinal cryptso Infiltration of lamina propria with# Plasma cells# Lymphocytes# Eosinophils# MacrophagesAll these features are more marked in proximal small intestine as they are more exposed to dietary glutenSerology in celiac sprueCeliac sprue is associated with following antibodieso Antigliadin antibodies (AGA)o Antireticulin antibodies (ARA)o Anti endomysial antibody (Anti EM A)o Anti tissue transglutaminase (Anti + TGA)Antigliadin and antireticulin tests are no longer doneTests with good accuracy are# Antiendomysial antibody test# Anti tissue (t) transglutaminase testRemember that the diagnosis of celiac sprue rests on :o Clinical documentation of malabsorptiono Demonstration of intestinal lesion by small bowel biopsyo Unequivocal improvement in both symptoms and mucosal histology on gluten withdrawl from the diet.
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