3.6 Coeliacs Diseease

Question 1

What antibodies are present in coeliacs disease?

Answer 1

Autoantibodies created in response to gluten target epithelial cells of intestine:

• anti-tissue transglutaminase (anti-TTG)
• anti-endomysial (anti-EMA)
• deaminated gliadin peptides (anti-DGPs)

Question 2

What must you also test when looking for anti-TTG and anti-EMA antibodies?

Answer 2

Check total IgA levels

–> anti-TTG and anti-EMA are IgA; patient may have IgA deficiency so test total IgA levels; if low, then test IgG versions

(abs rise with disease activity and disappear with treatment)

Question 3

Gene associations with coeliacs disease?

Answer 3

HLA-DQ2 gene (90%)

HLA-DQ8 gene

Question 4

What would you see on biopsy of coeliacs?

Answer 4

• crypt hypertrophy
• villous atrophy

Question 5

Presentation of coeliacs disease?

Answer 5

• failure to thrive, diarrhoea, weight loss, fatigue.
• mouth ulcers
• anaemia from iron, b12 or folate deficiency
• dermatitis herpetiformis (itchy blistering rash)

Question 6

What are some rare neuro presenations of coeliacs?

Answer 6

• peripheral neuropathy
• cerebellar ataxia
• epilepsy

Question 7

What group of people should you always test for coeliacs?

Answer 7

Test all Type 1 diabetics for coeliacs.

Question 8

6 other conditions that coeliacs disease is associated with?

Answer 8

• type 1 diabetics (test them)
• thyroid disease
• autoimmune hepatitis
• primary biliary cirrhosis
• primary sclerosing cholangitis
• Down’s

Question 9

8 complications of untreated coeliacs?

Answer 9

• vitamin deficiency
• anaemia
• oesteoporosis
• ulcerative jejunitis
• enteropathy-associated T-cell lymphoma (EATL) of the intestine
• non-hodgkin lymphoma (NHL)
• small bowel adenocarcinoma (rare)