Hello, everyone. Joe Vacari, co-chair of the ASG ATP task force and one of the faculty at this year's annual advanced practice provider course put on by ASGE. Once again, that's on March 31st and April 1st. And this is the first of three video tips of the week. I know everyone is busy, so we'll jump right into celiac disease. Celiac disease, as you know, is an immune disorder that is triggered by gluten in genetically predisposed individuals. As you also know, gluten causes an enteropathy of the mucosal layer of the small intestine, so the disease or the injury is in the mucosal layer of the small intestine. Classic pathologic changes include villous atrophy with complete loss of villi. In the United States, the prevalence of celiac is about one in 130 individuals. I think this is a really important point to understand who is at high risk. High risk groups include first and second degree relatives of patients with celiac disease. So in that way, we have to think about a familial component of celiac disease, patients with type 1 diabetes, autoimmune thyroiditis, and patients with Down and Turner syndromes. There are a number of definitions of celiac, and these include classic celiac, which is mostly a disease of GI symptoms, including diarrhea and malabsorption. A typical disease typically has some of the extra intestinal manifestations, and we'll talk about those in a moment. Latent disease is essentially you have that genetic predisposition, and for reasons that aren't entirely clear, the disease is perhaps a little slower to present itself with symptoms, and then refractory disease. GI manifestations, as I said, can include diarrhea, malabsorption, and weight loss. Extra intestinal manifestations are common. Some of the more common ones we see are anemia, iron deficiency anemia, B12 deficiency, folate deficiency, and osteoporosis. Diagnostic workup is pretty easy. It begins typically with serologic testing for TTG, IgA, and as all of you know, the gold standard for the diagnosis of celiac disease is duodenal mucosal biopsies. It's very important that these tests are obtained when patients are consuming a regular diet or specifically diets containing gluten. Finally, the management of celiac disease, and there's a very simple way to think about the management of celiac disease. There's a very nice acronym, CELIAC in all caps. C stands for consultation with dietician, E for education about the disease, L, lifelong adherence to a gluten-free diet, I, identification and treatment of nutritional deficiencies, A, access to an advocacy group, and C, continuous long-term follow-up. That concludes this week's video tip of the week. Once again, I'd like to remind all of you, the annual GI practice provider course is March 31st and April 1st of this year. It has an onboarding component on the first day. Clinical course starts later in the first day and on the second day. And always remember, we are all in this together, physicians, advanced practice providers, working together to build top-notch GI APP teams, delivering high-quality care to our patients. I look forward to seeing you next week.

celiac disease

gluten

immune disorder

small intestine

mucosal layer