{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 10, Ep 1 of 2: Celiac Diagnosis and Treatment","html":"","width":"100%","height":180,"duration":831,"description":"Celiac disease built from mechanism through monitoring: modified gluten peptides bind HLA-DQ2/DQ8, drive T-cell inflammation, and trigger lymphocyte-mediated villous atrophy. The modern adult presents like IBS, iron deficiency, or an extraintestinal finding, so the threshold to test is broad. Diagnosis is serology-anchored and biopsy-confirmed while the patient still eats gluten, treated by a strict lifelong gluten-free diet with structured monitoring.\n \nTopics covered\n\nPathogenesis and HLA-DQ2/DQ8\nExtraintestinal and IBS-like presentations\nSilent, potential, and seronegative phenotypes\nDermatitis herpetiformis\ntTG-IgA serology and total IgA\nDuodenal biopsy and Marsh classification\nGluten-free diet and nutritional repletion\nSerologic and histologic monitoring\n \n \nKey decisions\n\nOrder tTG-IgA plus a total IgA as first-line serology while the patient is still eating gluten; pivot to deamidated gliadin peptide IgG if IgA deficient.\nUse HLA-DQ2/DQ8 to exclude, never to confirm; it is not part of the initial algorithm.\nConfirm with at least four distal duodenal biopsies plus one or two bulb biopsies, since a minority have bulb-only atrophy.\nNo-biopsy adult diagnosis needs tTG greater than 10x upper limit plus a positive endomysial antibody on a second sample, but biopsy remains the adult default.\nA persistently positive antibody after one year means ongoing gluten exposure and prompts a dietitian re-evaluation, not a refractory workup.\nConfirm mucosal healing with a repeat duodenal biopsy at about two years, because negative serology can dissociate from persistent atrophy.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Celiac Disease and Sprue Spectrum\nRead this episode: boardpearls.com/gi/episodes/celiac-and-sprue-spectrum-ep1\nQuestions or feedback:...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}