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Beyond moulage sign and TTG levels: the role of cross-sectional imaging in celiac sprue

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Abstract

Celiac disease is an autoimmune disorder that causes inflammation and destruction in the small intestine of genetically susceptible individuals following ingestion of gluten. Awareness of the disease has increased; however, it remains a challenge to diagnose. This review summarizes the intestinal and extraintestinal cross-sectional imaging findings of celiac disease. Small intestine fold abnormalities are the most specific imaging findings for celiac disease, whereas most other imaging findings reflect a more generalized pattern seen with malabsorptive processes. Familiarity with the imaging pattern may allow the radiologist to suggest the diagnosis in patients with atypical presentations in whom it is not clinically suspected. Earlier detection allows earlier treatment initiation and may prevent significant morbidity and mortality that can occur with delayed diagnosis. Refractory celiac disease carries the greatest risk of mortality due to associated complications, including cavitating mesenteric lymph node syndrome, ulcerative jejunoileitis, enteropathy-associated T cell lymphoma, and adenocarcinoma, all of which are described and illustrated. Radiologic and endoscopic investigations are complimentary modalities in the setting of complicated celiac disease.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA

    Shannon P. Sheedy, John M. Barlow, Joel G. Fletcher & Jeff L. Fidler

  2. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Thomas C. Smyrk

  3. Department of Radiology, Lahey Clinic, Burlington, MA, USA

    Francis J. Scholz

  4. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Don C. Codipilly

  5. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Badr F. Al Bawardy

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  1. Shannon P. Sheedy
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Correspondence to Shannon P. Sheedy.

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Sheedy, S.P., Barlow, J.M., Fletcher, J.G. et al. Beyond moulage sign and TTG levels: the role of cross-sectional imaging in celiac sprue. Abdom Radiol 42, 361–388 (2017). https://doi.org/10.1007/s00261-016-1006-2

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