5.1. Intestinal Disease - Coeliac Disease

Question 1

What is Coeliac Disease?

Answer 1

An intolerance to the Gliadin in Gluten

Question 2

What type of disease is Coeliac Disease?

Answer 2

An autoimmune Inflammatory Bowel Condition

Question 3

Is Coeliac Disease more common in Males or Females?

Answer 3

Females

Question 4

At what ages is Coeliac Disease most prevalent?

Answer 4

1. In the 5th decade (40-50 years old)

2. In infancy - after weaning onto Gluten-Containing foods

Question 5

What are the Aetiological Agents a combination of?

Answer 5

Genetic and Environmental Factors

Question 6

What is the Familial Genetic prevalence of Coeliac Disease?

Answer 6

10-15% of 1st Degree relatives will have the Disease

Question 7

What genes are responsible for Coeliac Disease?

Answer 7

Human Leukocyte Antigen Genes (HLA Genes):

1. HLA-DQ2
2. HLA-DQ8

Question 8

What are the Environmental Factors which can effect Coeliac Disease?

Answer 8

1. A High Gluten Diet

2. Breast Feeding / Age of introduction to Gluten

Question 9

What percentage of the Population is effected by Coeliac Disease?

Answer 9

1%

Question 10

What is the Pathology of Coeliac Disease?

Answer 10

1. Gliadin in Gluten is resistant to Pepsin and Chymotrypsin Digestion so it remains in the Intestinal Lumen
2. This can trigger an immune response which attacks the Enterocytes

Question 11

What does the immune attack on the Enterocytes cause?

Answer 11

1. Villous Atrophy and Blunting
2. Lymphocytosis
   Resulting in the Enterocyte Epithelial Surface to become Cuboidal

Question 12

What improves the inflammation?

Answer 12

The removal of Gluten from the Diet

Question 13

What causes a relapse in improvement?

Answer 13

The re-introduction of Gluten into the Diet

Question 14

What is the Clinical Presentation of Coeliac Disease?

Answer 14

1. Asymptomatic (common)
2. Malaise / Tiredness
3. Malabsorption Symptoms
4. Abdominal Pain
5. Angular Stomatitis / Mouth Ulcers
6. Neuropsychiatric Conditions

Question 15

What are the Malaise / Tiredness often associated with?

Answer 15

Anaemia

Question 16

What symptoms can occur due to the Malabsorption?

Answer 16

1. Diarrhoea

2. Steatorrhoea

Question 17

What is the Abdominal Pain described as?

Answer 17

Distension / Bloating

Question 18

How often do Angular Stomatitis / Mouth Ulcers form?

Answer 18

They are intermittent but frequent

Question 19

What Neuropsychiatric Conditions may occur as a result of Coeliac Disease?

Answer 19

1. Depression

2. Anxiety

Question 20

What investigations are necessary in Coeliac Disease?

Answer 20

1. Seological Tests:
   a) Endomysial Antibodies
   b) Anti-Tissue Transglutaminase Antibodies
2. HLA Typing
3. Biopsy
4. Haematological Tests
5. Biochemistry
6. Endoscopy / Small Bowel Follow-Through

Question 21

What is the Advantage / Disadvantage of the 2 Serological Tests?

Answer 21

Advantage - They are very sensitive (greater than 90% sensitivity)
Disadvantage - They are not always positive

Question 22

What are the prevalence’s of each of the HLA types which cause Coeliac Disease?

Answer 22

HLA-DQ2 - present in 90-95% of cases

HLA-DQ8 - is 8% of cases

Question 23

What are the Histological Changes which would be seen on a Biopsy?

Answer 23

1. The Villous Atrophy
2. Crypt Hperplasia
3. Chronic inflammatory cells in the Lamina Propria
4. Flat Cuboidal Epithelial Cells

Question 24

What are the Haematological Tests looking for?

Answer 24

1. Anaemia
2. Folate / Iron Deficiencies
3. Vitamin B12 Deficiency

Question 25

What is being looked for in the Serum Biochemistry test?

Answer 25

Hypoalbuminaemia and Oesteomalacia which may appear in sever disease

Question 26

What might the Small Bowel Follow Through show?

Answer 26

Dilatation and Slow Transmit

Question 27

What is the Treatment for Coeliac Disease?

Answer 27

1. Dietary Change (Gluten Free)

2. Diet Supplements (for anything which is low, i.e. Iron Folic Acid, Calcium, Vitamin D etc,)