Coeliac Flashcards
what is the definition of coeliac disease?
autoimmune disease triggered by dietary gluten peptides
what is the epidemiology of coeliac disease?
Around 1% of population
Women more likely
what is the aetiology of coeliac disease?
Systemic autoimmune disorder triggered by gluten peptides from grains including wheat, rye, and barley
Carry one of two major histocompatibility complex class-II molecules (human leukocyte antigen [HLA]-DQ2 or -DQ8) that are required to present gluten peptides in a manner that activates an antigen-specific T cell response (genetic predisposition)
Possible research on timing of original gluten exposure, exposure to reovirus as baby etc
what are the risk factors for coeliac disease?
Family history
IgA deficiency
T1DM
Autoimmune thyroid disease
what is the pathophysiology of coeliac disease?
Loss of immune tolerance to peptide antigens derived from prolamins in wheat (gliadin), rye (secalin), barley (hordein), and related grains is the central abnormality of coeliac disease. These peptides are resistant to human proteases, allowing them to persist intact in the small intestinal lumen.
In the intestinal submucosa these peptides trigger both innate and adaptive immune activation. The mechanism of innate immune activation is not fully known. Gluten peptides are clearly able to stimulate interleukin-15 production by dendritic cells, macrophages, and intestinal epithelial cells, which then stimulate intraepithelial lymphocytes, leading to epithelial damage
what are the key presentations for coeliac disease?
IgA deficiency Diarrhoea Bloating Abdominal pain Anaemia
what are the signs of coeliac disease?
Family history T1DM Autoimmune thyroid disease IgA deficiency Anaemia
what are the symptoms of coeliac disease?
Diarrhoea Bloating Pain in abdomen Osteopenia Fatigue Weight loss Failure to thrive
what are the first line and gold standard investigations for coeliac disease?
FBC and smear - anaemia IgA-tTG - above normal range igG DGP IgG-tTG Skin biopsy Small bowel endoscopy Small bowel histology (Gold standard and diagnostic)
what are the differential diagnoses for coeliac disease?
Peptic duodenitis, crohns, giardiasis
how is coeliac managed?
Gluten free diet
Vitamin and mineral support
how is coeliac monitored?
IgA-tTG titres are typically checked at least three times in the first year following the diagnosis (3 months, 6 months, and 12 months), and then yearly as an indication of diet adherence
what are the complications of coeliac disease?
osteoporosis , dermatitis herpetiformis, malignancy, acute pancreatitis, pneumococcal infection, non-response to hep B vaccine
what is the prognosis if coeliac disease?
Good, 90% complete recovery, 10% lasting symptoms of lactose intolerance and IBS
