19.1 Coeliac disease and inflammatory bowel disease Flashcards
What is coeliac disease?
A sensitivity to gluten, a protein found in wheat, barley and rye, which causes an immune reaction in the lining of the bowel and sometimes the skin (dermatitis herpetiformis).
What causes coeliac disease?
There is a genetically inherited susceptibility to the condition, but other factors are believed to be required to trigger the condition such as severe emotional stress, pregnancy, infection.
How prevalent is coeliac disease?
1 in 100 people are affected.
1 in 500 are diagnosed.
How is coeliac disease diagnosed?
Through a blood test for anti-tissue trans-glutaminase antibodies.
What are the effects of coeliac disease on the gastrointestinal tract?
- Villus atrophy: gluten damages the villi lining the small intestine
- Leads to diarrhoea, poor absorption of fats, proteins, iron, vitamins etc.
- Can be diagnosed through an endoscopic biopsy
What are the effects of coeliac disease on the skin?
- Dermatitis herpetiformis
- On the back of arms and front of legs
- Skin biopsy
What are the effects of coeliac disease on the skeletal system?
- Joint pain
- Osteoporosis
Name other symptoms of coeliac disease.
- Stunted growth in infants due to poor nutrition
- Anaemia due to iron and vitamin deficiencies
- Reduced fertility if untreated
- Neurological problems
- Enamel defects
- Recurrent aphthous ulceration
Describe the onset of coeliac disease.
- More predominant in women than men
- Peak age of diagnosis in midlife
- Also commonly diagnosed in babies (stunted growth)
How is coeliac disease treated?
- Lifelong dietary avoidance: gluten free diet
- Switch from wheat-based products to rice-based, potato-based, maize, buckewheat
- Vitamin replacement e.g. iron, folate, calcium, B12
- Treatment of osteoporosis (main complication due to malabsorption of vitamin D and calcium), scans to check bone density and prescribe medicine where necessary
What is IBD?
Chronic, relapsing and remitting (gets better and worse intermittently) inflammatory GI tract disorder of unknown cause.
What are the 2 types of IBD?
- Ulcerative colitis
- Crohn’s disease
What is the difference between ulcerative colitis and Crohn’s?
- Colitis is inflammation of the colon, only involves the large intestine
- Crohn’s can affect any part of the GI tract
- Crohn’s can present as oral ulcers, anal ulceration (perianal Crohn’s disease)
What is the difference in depth of involvement between ulcerative colitis and Crohn’s?
- Crohn’s can affect the full thickness of the gut, including the outside of the gut (serosa)
- Ulcerative colitis only involves the mucosa and submucosa
What are the 3 main patterns of presentation of Crohn’s?
Because the full thickness of the gut layers can be involved, there are 3 main patterns of behaviour:
- Inflammatory
- Stenotic
- Fistulising
What is inflammatory Crohn’s?
- Wall of bowel inflamed
- Can cause malabsorption of vit B12
- Bowel narrowing
- Diarrhoea
What is stenotic Crohn’s?
- Narrowed bowel wall creates blockage
- Causes adjacent part to become distended
- Causes obstruction, vomiting and pain
What is fistulising Crohn’s?
Parts of the gut stick/connect to other organs e.g. bladder, vagina, skin. Creates fistulae.
Painful and unpleasant.
What are the different extents of ulcerative colitis?
UC can affect different parts of the large intestine.
- Procitis: only affecting the lower end of the large intestine
- Left sided
- Pancolitis: entire large intestine affected
UC always affects the lower part of the bowel.
Extent of UC dictates treatment choice.
What is the prevalence and epidemiology of IBD?
- Most prevalent in Europe, Canada and USA
- Intermediate levels in Australasia and South Africa
In the UK:
- 1 in 500 have UC
- 1 in 1000 have Crohn’s
Peak onset of UC and Crohn’s is early to mid-20s.
Slight male predominance with Crohn’s.
What are the causes of IBD?
Seems to be a combination of genetic and environmental factors.
- Family history = increased risk
- Several genes identified with increased risk
- Luminal antigens
- Environmental triggers: gut infections, antibiotics, NSAIDs, diet, stress, smoking
What are the blood test findings in patients with IBD?
- Decreased haemoglobin, albumin, iron, folate, B12
- Increased ESR, CRP, WBC, platelets, faecal calprotectin
What are the differences in symptoms between UC and Crohn’s?
What are the extraintestinal manifestations of IBD related to disease activity?
Inflammation of joints, eyes and skin
How is IBD treated?
- Medication (steroids, immunosuppressive drugs, biologic therapy)
- Lifestyle changes (diet)
- Surgery (post operative recurrence of Crohn’s is common, surgery is not a common treatment choice)
- Nutritional support
- Emotional support
What are the oral consequences of Coeliac disease?
- Dental enamel defects, enamel hypoplasia
- Tooth discolouration
- Mottled teeth
- Delayed eruption
- Aphthous ulcers
What are the oral consequences of Crohn’s disease?
- Recurrent aphthous ulcers
- Oral granulomatosis
- Gingivitis
- Angular cheilitis
- Immunosuppressive drugs can lead to oral thrush
What are the oral consequences of ulcerative colitis?
- Aphthous ulcers
- Xerostomia
- Pyostomatitis vegetans (pustules on the oral mucosa)
Compare the possible oral conditions associated with Crohn’s vs UC.
Extensive, don’t need to know every single one.
