
==== Front
Spartan Med Res J
Spartan Med Res J
1364
Spartan Medical Research Journal
2474-7629
MSU College of Osteopathic Medicine Statewide Campus System Website: Spartan Medical Research Journal

122925
10.51894/001c.122925
Research Symposium
CELIAC DISEASE PRESENTING WITH DUODENAL ULCERATION
Rigby Mark DO 1
1 Internal Medicine Ascension Genesys
31 8 2024
2024
9 2 ABSTRACTS FROM THE SECOND ANNUAL RESEARCH DAY HOSTED BY THE MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE, NOVI, MICHIGAN, APRIL 11, 2024. 12292516 7 2024
31 7 2024
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
==== Body
pmc50

INTRODUCTION

Celiac disease (CD) is a rare, gluten-mediated autoimmune disease with an approximate 1% global prevalence. Here, we discuss the case of a 24-year-old female diagnosed with CD after serologic evaluation and biopsy of rare superficial duodenal ulcerations masquerading as inflammatory bowel disease.

CASE DESCRIPTION

A 24-year-old female with a family history of ulcerative colitis presented with two months of non-bloody, non-bilious emesis. She had associated epigastric and right upper quadrant (RUQ) pain with radiation to the right shoulder, and 30-pound, unintentional weight loss with 7-8 episodes of watery diarrhea per day. She denied previous endoscopy or NSAID use. A negative HIDA scan prompted bi-directional endoscopy which revealed esophagitis, gastritis, superficial duodenal ulcers, with no evidence of colon inflammation. Fecal calprotectin, celiac serology, and fasting gastrin levels revealed elevated tTG-IgA with normal total IgA levels, consistent with celiac sprue. Duodenal biopsy pathology revealed villous attenuation and increased intraepithelial lymphocytes.

DISCUSSION

Classic signs and symptoms of CD include steatorrhea, weight loss, anemia, and dermatitis herpetiformis. The clinical presentation of this patient was unusual in multiple ways. Nausea and vomiting with RUQ and epigastric abdominal pain with radiation to the right shoulder seemed classic for a biliary origin of disease. The patient’s diarrhea, abdominal pain, weight loss, anemia and family history of ulcerative colitis was suspicious for inflammatory bowel disease. It is rare to find duodenal ulcers at the time of diagnosis of CD. If ulceration occurs, it is more common in an advanced course of the disease and is typically found more distally in the small bowel or colon. Our patient presented with duodenitis and multiple superficial ulcers extending from the duodenal bulb to the second portion of the duodenum. Biopsies remarkable for villous attenuation and increased intraepithelial lymphocytes were characteristic of CD. Both serologic testing and endoscopy with biopsy help aid in diagnosis. tTG-IgA antibody is the preferred test for detection of celiac disease in adults. Adherence to a gluten free diet is pertinent for disease remission.

CONCLUSION

Clinicians should be aware of atypical CD presentation. Failure to recognize atypical presentations may lead to increased morbidity, mortality and health expenditure.
