ABIM Exam Disease of the Week Profile: Celiac Disease

Celiac disease is an important area to understand, concepts of which may be seen on the ABIM Board Exam. That’s why it’s this week’s ABIM Exam Disease of the Week.


Celiac disease (gluten sensitive enteropathy) is an autoimmune condition in which individuals develop an allergy to gluten. This protein is found in many products humans have been consuming for millennia. Among them are wheat, rye, oat, and barley. People of western European descent are at greatest risk of being diagnosed. Afflicted patients with the classic presentation will primarily have gastrointestinal symptoms like abdominal pain and foul-smelling diarrhea.


Although gastrointestinal symptoms predominate with celiac disease, some patients display the complications of the illness before developing abdominal discomfort. These patients may show iron deficiency, microcytic anemia, osteoporosis (from poor absorption of the fat-soluable vitamin D), arthritis, and transaminitis. Neuropsychiatric symptoms like depression are also associated. The classic rash seen in celiac disease is dermatitis herpetiformis (itchy papular vesicles covering the extensor surface of the arms).


Celiac disease is more common in individuals with other autoimmune diseases like type 1 diabetes mellitus or Hashimoto’s thyroiditis. When celiac disease is suspected, the most specific antibody to check is anti-tissue transglutaminase (IgG and IgA) in the blood. If this antibody is elevated, the chances of celiac disease are high.


Although the tissue transglutaminase antibody is specific for celiac disease, EGD with biopsy is required for confirmation. The biopsy can show villous atrophy and crypt hyperplasia. If celiac disease is undiagnosed or left untreated, it can lead to non-Hodgkin’s lymphoma.


Treatment for celiac disease currently is adhering to a gluten-free diet for life. Corticosteroids can play a role in refractory disease. In the future, patients may find relief with zonulin inhibitors such as larazotide acetate. This class of medication, which is still being studied, can prevent tight junction opening and potentially reduce gluten uptake.


According to celebrity watchers’ reports, famous people who have been diagnosed with celiac disease include Novak Djokovic, Zooey Deschanel, Billy Bob Thornton, and Keith Olbermann.


You can see all the previous ABIM Exam disease of the week blog posts at the Knowmedge Blog. You can find also additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.

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