Abdominal: Coeliac disease (brief)

Question 1

what is coeliac disease?

Answer 1

autoimmune disorder in which a heightened immunological response to gluten

Question 2

what does coeliac disease result in/cause?

Answer 2

chronic inflammation and damage (villous atrophy) to the lining of the small intestine = malabsorption of nutrients

Question 3

with reference to coeliac disease, which auto-antibodies are created in response to gluten?

Answer 3

anti-TTG and anti-EMA

Question 4

what is refractory coeliac disease?

Answer 4

the persistence or recurrence of otherwise unexplained malabsorptive symptoms and villous atrophy despite adhering to a gluten-free diet

Question 5

what are clinical features of coeliac disease?

Answer 5

• unexplained, persistent, GI symptoms
• failure of growth in children
• unexpected weight loss
• fatigue.
• iron/B12/folate deficiency
• IBD

Question 6

what differential diagnosis could you offer for coeliac disease?

Answer 6

• IBD/IBS
• malignancy
• infectious (TB or HIV)
• milk allergy
• aphthous ulcer

Question 7

what investigation would you conduct to diagnose coeliac disease?

Answer 7

serology testing:

The NICE GDG recommends testing for immunoglobulin (IgA),tissue transglutaminase antibody (tTGA) first-line, and using IgA endomysial antibody (EMA) for cases where IgA tTGA is weakly positive, as this approach has high specificity and only slightly reduced sensitivity.

Question 8

what is the treatment for coeliac disease?

Answer 8

long-term gluten free diet is only effective treatment