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Celiac Disease with Diffuse Intestinal Ulceration


Presentation

  • We report a 12-year female who presented with simultaneous celiac disease and acute pancreatitis Case Presentation A 12-year girl was referred to the ER with one day history of severe epigastric abdominal pain and vomiting.[omicsonline.org]
  • The cell of origin of indolent small intestinal CD4 T-cell lymphomas is not known at present.[journals.plos.org]
  • Definition / general Enteropathy associated T cell lymphoma (EATL) is an intestinal tumor of intraepithelial T lymphocytes showing varying degrees of transformation but usually presenting as a tumor composed of large, often polymorphic lymphoid cells,[pathologyoutlines.com]
  • Raynaud phenomenon is present in most patients with SSc and is often the earliest manifestation of disease.[emedicine.medscape.com]
Physician
  • .), FACP, Pro Vice-Chancellor, Global Research, University of Newcastle, Australia Professor of Medicine, Faculty of Health and Medicine, University of Newcastle, Australia President, Royal Australasian College of Physicians Chair-Elect, Committee of[books.google.com]
  • American Family Physician [On-line journal]. Available online at through . (2000 September). Celiac Disease. Familydoctor.org [On-line information]. Available online at through . Semrad, C. Celiac Disease and Gluten Sensitivity.[labtestsonline.it]
  • Diagnosis In addition to taking a medical history and performing a physical examination, physicians may request the following diagnostic procedures in order to diagnose IBD: blood tests to determine if there is anemia resulting from blood loss, or if[ariahealth.org]
  • If the blood tests and the person's symptoms suggest celiac disease, the physician will perform a biopsy of the small intestine.[westchestergi.com]
Pathologist
  • Stanley is a pathologist in private practice in Nobleboro, Maine, and an editor for DynaMed. Dr.[clinicaladvisor.com]
  • Greater awareness of this entity among clinicians and pathologists should lead to the discovery of more cases, which could facilitate elucidation of the etiology of these lymphomas and development of targeted therapy.[journals.plos.org]
Amyloidosis
  • […] diarrhea and weight loss • Treated with long term antibiotics-penicillin • Very rare Imaging • The hallmarks of the disease are nodules and a markedly thickened bowel wall (picket-fence) • Small bowel may or may not be dilated • Affects jejunum mostly Amyloidosis[learningradiology.com]
Chronic Fatigue Syndrome
  • Diagnosis The symptoms of celiac disease can be easily confused with those of other diseases such as irritable bowel syndrome, chronic fatigue syndrome, inflammatory bowel disease, or intestinal infections.[westchestergi.com]
Weight Gain
  • To investigate her hypoalbuminemia and poor weight gain, a tissue transglutaminase IgA (tTG) was obtained.[omicsonline.org]
Diarrhea
  • Traveler’s diarrhea Traveler’s diarrhea is the abnormally swift passage of watery waste material through the large intestine, with consequent discharge of loose feces. Traveler’s diarrhea is accompanied by cramping and lasts a few days.[britannica.com]
  • Drugs to control diarrhea and intestinal spasms can sometimes help relieve cramps and diarrhea. Infusion with the monoclonal-antibody drug infliximab can help patients who have not gotten adequate response from other therapies. diet.[ariahealth.org]
  • • Does not have increased secretions as does sprue • May be associated with pneumatosis intestinalis Whipple’s Disease • Glycoprotein in the lamina propria of the small bowel is Sudan-negative, PAS-positive • Clinically: arthralgia, abdominal pain, diarrhea[learningradiology.com]
  • Young children most often show growth failure, weight loss, diarrhea, constipation or abdominal distension.[westchestergi.com]
  • Intestinal damage causes diarrhea and poor absorption of nutrients, which may lead to weight loss. Abdominal pain, swelling (distention), and food intolerances are common in celiac disease.[icdlist.com]
Intestinal Disease
  • Nassar, V.H., Salem, P.A., Shadid, M.J.: Mediterranean abdominal lymphoma or immunoproliferative small intestine disease. II Pathological aspects.[link.springer.com]
  • Van Weyenberg SJ, Bouman K, Jacobs MA, Halloran BP, Van der Peet DL, Mulder CJ, et al: Comparison of MR enteroclysis with video capsule endoscopy in the investigation of small-intestinal disease. Abdom Imaging 2013;38:42-51.[karger.com]
  • Erythema nodosum lesions usually parallel the intestinal disease, which provides helpful information on the overall disease. Histologically, the lesions are characterized by septal panniculitis.[emedicine.medscape.com]
Rectal Bleeding
  • During childhood, symptoms include massive watery diarrhea, abdominal pain, painless rectal bleeding, and chronic anemia. The polyps can be quite large, leading to intussusception and intestinal obstruction.[emedicine.medscape.com]
Night Sweats
Headache
  • Neurological problems have also been associated with celiac disease; these include migraine headaches, depression, attention deficit hyperactivity disorder (ADHD), and recurrent seizures (epilepsy).[icdlist.com]
  • A 61-year-old man with headache and multiple infarcts. N Engl J Med. 2002 Oct 10. 347(15):1187-94. [Medline]. Thiers BH, Sahn RE, Callen JP. Cutaneous manifestations of internal malignancy. CA Cancer J Clin. 2009 Mar-Apr. 59(2):73-98.[emedicine.medscape.com]
Cerebral Calcification
  • […] syndrome Celiac infantilism Celiac rickets Cerebral calcification Congenital celiac disease Gluten sensitivity Infantilism Megaloblastic anemia due to disease of small intestine Megaloblastic anemia due to impaired absorption of folate Megaloblastic[icdlist.com]

Workup

  • Conclusions: Small bowel imaging and especially cross-sectional enteroclysis techniques are important extensions to the diagnostic workup of clinicians involved in the care of patients with celiac disease, especially those with suspected complicated disease[karger.com]
  • A thorough workup of the patient should also be done, with at least a chest radiograph, CBC count, and liver panel, but also other imaging directed by the patient’s symptoms.[emedicine.medscape.com]
Staphylococcus Aureus
  • Other less common pathogens include Bacillus cereus, Clostridium perfringens, Clostridium difficile and Staphylococcus aureus. [6] Campylobacter jejuni is one of the most common sources of infectious enteritis, and the most common bacterial pathogen found[en.wikipedia.org]
Colitis
  • Stay up to date with emerging and challenging topics: enteric microbiota and probiotics; fecal microbiota transplantation; Clostridium difficile colitis; and factitious gastrointestinal diseases.[books.google.com]
  • Ulcerative colitis and Crohn's disease generally require long-term medical care.[ariahealth.org]
  • Vascular disease [ edit ] Ischemic enteritis is uncommon compared to ischemic colitis due to the highly vascularised nature of the small intestine, [12] allowing for sufficient blood flow in most situations.[en.wikipedia.org]
  • Diarrhea affected a small proportion of children with recessive dystrophic EB with changes of colitis in the majority of patients.[emedicine.medscape.com]
Multiple Ulcerations
  • ulcerated mucosal masses, also single / multiple ulcers or large exophytic mass Gross images Images hosted on other servers: Well defined mural mass Resected small intestine with multiple patchy segmented lesions Microscopic (histologic) description[pathologyoutlines.com]
  • Endoscopic evaluation may demonstrate marked generalized redness, raised lesions, multiple ulcerations, or diffuse erosive lesions. [84] A retrospective study aimed at determining the distribution of GI involvement in seven patients with HSP found the[emedicine.medscape.com]
Liver Biopsy
  • Review Topic QID: 101101 1 CT scan showing inflammation of the small bowel wall 2 Biopsy of the duodenum showing atrophy and blunting of villi 3 Biopsy of the colon showing epithelial cell apoptosis 4 Liver biopsy showing apoptosis of hepatocytes 5 Esophageal[medbullets.com]
HLA-DQ2
  • […] disease is rare (Asia) Etiology Lymphomas of small intestine may derive from various subsets of intestinal intraepithelial lymphocytes that are differentially activated by diverse antigenic stimuli Association with celiac disease: positive serology, HLA[pathologyoutlines.com]
  • Celiac Disease and HLA-DQ2/DQ8 eMedicine [On-line information]. Available online at through . Accessed November 2010. Klapproth, J. and Yang, V. (Updated 2009 September 2). Celiac Sprue. eMedicine [On-line information]. Available online at through .[labtestsonline.it]

Treatment

  • Incorporate the latest findings and improvements in care for liver disease patients —from diagnosis and treatment through post-treatment strategies and management of complications. Expert Consult eBook version included with purchase.[books.google.com]
  • […] months after treatment.[en.wikipedia.org]
  • Most patients with IBD will not require surgery, a treatment typically reserved for those for whom drug therapy and other treatments have not been successful.[ariahealth.org]
  • Withdrawal of NSAID treatment usually allows the ulcer to heal. Treatment for H. pylori –induced ulcers are antibiotics and a proton pump inhibitor.[britannica.com]
  • However, the treatment of scurvy is simply food containing vitamin C. Therefore, the therapeutic challenge in scurvy is in identifying patients needing treatment.[emedicine.medscape.com]

Prognosis

  • […] celiac disease diagnosed simultaneously with lymphoma in most patients Abdominal pain, often intestinal perforation, sometimes prodrome of refractory celiac disease accompanied by ulceration (ulcerative jejunitis - UJ) Prognostic factors Treatment and Prognosis[pathologyoutlines.com]
  • .: Occurrence and prognosis of extranodal lymphomas. Cancer 29 :252, 1972 Google Scholar 7. Novis, B.H.: Primary intestinal lymphoma in South Africa. Isr. J. Med. Sci. 15 :386, 1979 Google Scholar 8.[link.springer.com]
  • However, owing to the poor prognosis of glucagonomas, the outcome of this condition is also poor.[emedicine.medscape.com]
  • Diagnosis, management, and prognosis. J. Am. Acad. Dermatol. 64, 1027–1033 (2011). 59. Jaskowski, T. D. et al. IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis and pediatric celiac disease. J. Invest.[nature.com]
  • Primary T/NK-cell lymphomas of the intestine are associated with a poor prognosis and a high risk of bowel perforation. [6] – [8] However, rare cases of primary GI indolent lymphoproliferative disorders of CD8 and CD4 T-cell lineages have been described[journals.plos.org]

Etiology

  • ) Higher frequency in areas with high prevalence of celiac disease (northern Europe) Monomorphic variant (type II EATL): 10% - 20% of cases of EATL, broader geographic distribution and sporadic occurrence in areas where celiac disease is rare (Asia) Etiology[pathologyoutlines.com]
  • Etiologies and predictors of diagnosis in nonresponsive celiac disease. Clin. Gastroenterol. Hepatol. 5, 445–450 (2007). 61. Ludvigsson, J. F., Lindelof, B., Zingone, F. & Ciacci, C.[nature.com]
  • Genetic susceptibility, anatomical abnormalities, medications, trauma, infectious etiologies and metabolic causes are the primary risk factors for pediatric pancreatitis.[omicsonline.org]
  • The etiology of indolent small intestinal CD4 T-cell lymphomas is unclear. Persistent antigenic stimulation as a consequence of an immune-mediated or infectious disorder is a possibility.[journals.plos.org]
  • The cutaneous findings can be categorized into four main groups based on etiology.[emedicine.medscape.com]

Epidemiology

  • Epidemiological study by Ludvigsson et al. [ 5 ] has suggested that patients with celiac disease have a higher risk than the general population for the development of acute pancreatitis.[omicsonline.org]
  • Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics. Brain 126, 685–691 (2003). 70. Hadjivassiliou, M. et al.[nature.com]
  • […] lymphoid cells, which are negative for CD56 Terminology Also called intestinal T cell lymphoma (with or without enteropathy), but many other T cell lymphomas can present with intestinal involvement ICD coding ICD-O: 9717 / 3 - intestinal T cell lymphoma Epidemiology[pathologyoutlines.com]
  • The Spectrum of Celiac Disease: Epidemiology, Clinical Aspects and Treatment. Medscape from Nat Rev GastroenterolHepatol. 2010;7(4):204-213. [On-line information]. Available online at through . Accessed November 2010.[labtestsonline.it]
  • Communicable Disease Epidemiology and Control: A Global Perspective. CABI. ISBN 9781845935054. External links [ edit ][en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features. Elsevier Health Sciences. ISBN 978-1437727678. Webber, Roger (2009-01-01).[en.wikipedia.org]
  • […] most cases, NAE is associated with hepatitis C infection, [72] although several cases have occurred in patients without hepatitis C. [73, 74] Overall, it is a rare entity, with one study showing a prevalence 1.7% in patients with hepatitis C. [75] The pathophysiology[emedicine.medscape.com]

Prevention

  • When gluten is removed from the diet, symptoms improve, the small intestine begins to repair the existing damage, and further damage is prevented.[westchestergi.com]
  • "Radiation Enteropathy – Pathogenesis, Treatment, and Prevention". Nature Reviews. Gastroenterology & Hepatology. 11 (8): 470–479. doi : 10.1038/nrgastro.2014.46. ISSN 1759-5045. PMC 4346191. PMID 24686268. Gregg, null; Nassar, null (1999-04-01).[en.wikipedia.org]
  • ) 200 mg p.o. b.i.d. may decrease symptoms of gastritis Ursodeoxycholic acid (Actigall) 1,000 mg daily may decrease symptoms of bile reflux gastritis Various antioxidants and Chinese herbs reported to be beneficial in patients with chronic gastritis Prevention[clinicaladvisor.com]
  • No special diet has been proven effective for preventing or treating Crohn's disease. Certain symptoms are sometimes made worse by milk, alcohol, hot spices, or fiber, but this may not be true for everyone.[ariahealth.org]
  • Proton pump inhibitors, such as omeprazole, lansoprazole, and rabeprozale, inhibit the ATPase enzyme inside the parietal cell and prevent acid secretion.[britannica.com]

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