Celiac sprue (Gluten-sensitive enteropathy):

- Flattening villi of proximal small bowel (jejunum)
- HLA DQ2\DQ8
- 50% have iron deficiency anemia
- Associated with: Dermatitis herpetiformis (papulovesicular lesions on extensor surface), DM type 1, other autoimmune, IgA deficiency
- Diagnosis:
- Anti-endomysial antibody, Tissue tranglutaminase (tTG), Antigliadin antibody
- Biopsy to exclude bowel wall lymphoma (minimum of 6 taken from 2nd and 3rd part of duodenum)
- Gold standard: repeat endoscopy w\biopsy after gluten-free diet.
- Treatment: gluten-free diet, treat nutritional deficiencies
Whipple disease:
- Usually in middle-aged men
- Caused by gram-positive bacillus (Tropheryma whippelii)
- Presentation: diarrhea, steatorrhea, abdominal pain, wt loss, migratory arthritis, fever, neurologic, cardiac and ophthalmologic manifestations
- Diagnosis: PAS-positive machrophages containing the bacillus in small bowel, PCR
- Treatment: trimethoprim-sulfamethoxazole for 1 year
Bacterial overgrowth:
- Causes:
- Small bowel stasis: due to anatomic abnormalities (post-surgical), or abnormal motility (DM)
- Abnormal communication between small bowel and colon (Crohn fistula)
- Diagnosis:
- Lactose: hydrogen breath test (early hydrogen peak),
- 14C-D-Xylose breath test
Irritable bowel syndrome (IBS):
- Sx aggravated by stress
- Dome III dx criteria:
Inflammatory bowel disease (IBD):
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References:
- USMLE step 1
- The Johns Hopkins Internal Medicine Board Review
- Step up to medicine
- Master the boards