Ulcerative Jejunitis

Pediatric Ulcerative Jejunitis

as a complication of Celiac Disease: A Case Study

Case study

The 9 year old girl presented with a history of abdominal pain and vomiting.

• Slightly elevated IgA levels and...

What does this mean?

For adults, normal IgA levels are:

600–4,000 mg/L

• Broad villi aren't supposed to be found in the jejunum (less absorption).
• Less folds = celiac disease. more folds= normal.
• scalloping is commonin celiac patients

Intraepithelial lymphocytes (IEL)

indicative of celiac disease

How it’s diagnosed

Ulcerative Jejunitis

• Small bowel biopsy

Celiac Disease

IEL Levels

Adults -> up to 40 IEL/100 epithelial cells

• some suggest anything above 25 is abnormal

("Significance of IEL, 2014)

So... Compare this to her 88/100...

*Cleveland Clinic Image

• Serological levels of IgA (antibody found in mucosal linings)

• In children, 10x the normal would be considered a significant finding.

Ulcers of the small bowel, requiring surgical intervention

Sources (in order of use)

Sigman, T., Nguyen, V., Costea, F., Sant'Anna, A., & Seidman, E. G. (2014). Ulcerative jejunitis in a child with celiac disease. BMC Gastroenterology, 14(1), 1-14. doi:10.1186/1471-230X-14-29

Overview of disease

Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American society for pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr 2005, 40(1):1–19.

• Rare complication of CD
• Typically found in adults 50-60 years old
• Never before seen in children

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/celiac-disease-malabsorptive-disorders/#t002

Jan Bure, Stanislav Rejchrt1, Marcela Kopáãová1, Ilja Tachecí1, Zdenûk Papík1, Milan ·irok, Oldfiich Pozler2. "Endoscopic features of coeliac disease". www.pro-folia.org/files/1/2005/1/bures.pdf‎

Caceci, Thomas. http://www.vetmed.vt.edu/education/curriculum/vm8054/Labs/Lab19/Lab19.htm

Significance of Intraepithelial Lymphocytosis of the small intestine and its differential diagnosis. (n.d.). Pathology Laboratory. Retrieved April 15, 2014, from http://www.pathlab.ws/About/DisplayEdPrograms.asp?EPID=%7BB72E5258-02E1-405A-9BAC-BA51E13596A3%7D

• Also known as gluten-sensitive enteropathy
• Autoimmune disorder determined by genes
• Inflammation in the small intestinal mucosa following the ingestion of gluten,
• Gluten is a protein found in grains (wheat, rye and barley)

Common treatments

Stay away from the Gluten!

(Sigman, 2014)

No Gluten

No inflammation

No irritability/symptoms

What about lactose?

Clinical manifestations

• Experiences range
• Asymptomatic to having one or more symptoms

GI symptoms include: abdominal pain, vomiting, diarrhea and bloating.

Symptoms outside of the GI tract include: malnutrition and growth, osteoporosis, infertility, neurological symptoms, osteoporosis, and arthritis.

(Sigman, 2014)