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Or folate deficiency, osteoporosis, indigestion, dental enamel defects labs: elevated serum iga except in those with iga deficiency (more common in these patients than normals); also iga anti-transglutaminase, antiendomysial, antireticulin and antigliadin antibodies serum iga: used to monitor compliance with gluten-free diet antitransglutaminase antibody: sensitive marker of disease iga anti-endomysial antibody: detect with monkey esophageal tissue; sensitive and specific, although also positive in dermatitis herpetiformis iga and igg anti-gliadin antibody: less sensitive than antitransglutaminase and antiendomysial antibodies anti-reticulin antibody: in 40%, but nonspecific; also seen in crohn's disease, myasthenia gravis, sjogren’s, other diagnosis: antitransglutaminase or antigliadin or antiendomysial antibodies plus clinical malabsorption plus typical histologic findings plus improvement in symptoms and histology after gluten withdrawal complications: long term risk of malignant disease is 2x normal, usually t cell intestinal lymphomas; also gi or breast carcinomas or esophageal squamous cell carcinoma   celiac sprue - small bowel chapter (continued)   case reports: case of the week #127 treatment: improves clinically and microscopically after dietary withdrawal of wheat gliadins and related grain proteins gross: usually flat, scalloped mucosa; may be normal micro: increase in intraepithelial lymphocytes, including initial and most sensitive marker, 40+ lymphocytes per 100 surface or upper crypt enterocytes; early-clustering of 12+ lymphocytes at tip of villi and extending evenly down the sides of the villus ( mod path 2003;16:342 ); diffuse enteritis with marked atrophy or total loss of villi; fat globules in surface epithelium, enterocytes have stratified nuclei, lose their brush border, increased crypt mitotic figures; crypts are elongated and hyperplastic, but overall mucosal thickness is the same also increase in plasma cells in lamina propria; changes more marked in proximal small bowel (greater exposure) and abnormalities recede last here after gluten withdrawal; neutrophils, if present, are not prominent note: pathology report can only state consistent with celiac sprue micro images: image #1;  #2;  #3;  #4 case of the week - small bowel #1;  #2 micro virtual slide: image1   celiac sprue - small bowel chapter (continued)   dd: ▪ severe tropical sprue (no antiendomysial antibodies, responds to antibiotics and folate), ▪ dermatitis herpetiformis (associated with gluten-sensitive enteropathy but also has skin l. cheap viagra cheap viagra viagra without a doctor prescription http://nationalityinworldhistory.net/bsh-buy-viagra-on-the-internet-xd/ generic viagra online pharmacy india cheap generic viagra viagra tablets order online viagra online without prescription buy generic viagra viagra without a doctor prescription

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