67. Coeliac Disease and IBS

Question 1

How does ceaoliacs disease present?

Answer 1

Typically in children

Presents in adults with diarrhoea and weight loss and aneamia
Steatorrheoa, abdo pain
Bloating, nausea and vomiting
Fatigue, weakness

Question 2

What rash is associated with coeliacs disease?

Answer 2

Dermatitis herpetiformis

Question 3

What genes are associated with coeliacs disease?

Answer 3

HLA, DQ2, DQ8

Question 4

How do you test for coeliacs disease?

Answer 4

Anti TTG antibodies. 
IgA antibody (no anti ttg if no IgA)
Duodenal biopsy (must be eating gluten)
Genotyping May help if any residual doubts

Question 5

What do you expect to see on a duodenal biopsy?

Answer 5

Subtotal villous atrophy

Increased intra-epithelial WBC’s and crypt hyperplasia

Question 6

What are the complications of coeliacs disease?

Answer 6

Aneamia, 
Dermatitis herpetiformis
Ostepenia/osteoporosis
Hyperslpemism
GI malignancies

Question 7

What is IBS?

What causes it?

Answer 7

A functional disorder of the GI tract.

Caused by disorders of intestinal motility, enhanced visceral perception, microbial dysbiosis

Question 8

What are the symptoms of IBS?

Answer 8

Recurrent abdominal pain
Relieved by defacation
Altered stool form
Altered bowel frequency 
Chronic 
May be associated with urgency, increased frequency

Question 9

What are the differentials for IBS?

Answer 9

Ovarian pathology
Endometriosis
Cancer
IBD

Question 10

What would you make you think of another cause and not IBS?

Answer 10

Over 60

History less than 6 months

Low weight

Waking at night

Mouth ulcers

Abnormal inflammatory markers

Question 11

How do you treat IBS? (4)

Answer 11

Treat the symptoms!

Constipation- ensure good fibre and exercise, laxatives May have a role

Diarrhoea- reduce fibre, alcohol and caffeine intake. Try a bulking agent

Colic- mbeverine, hyoscine butyl-bromide

Psychological- emphasise the positive, hypnosis, tricyclics