Coeliac Flashcards
What is coeliac disease?
Coeliac disease is an autoimmune condition where exposure to gluten causes an autoimmune reaction that causes inflammation in the small bowel. It usually develops in early childhood but can start at any age.
How does it occur?
In coeliac disease, auto-antibodies are created in response to exposure to gluten that target the epithelial cells of the intestine and lead to inflammation. There are two antibodies to remember: anti-tissue transglutaminase (anti-TTG) and anti-endomysial (anti-EMA).Inflammation affects the small bowel, particularly the jejunum. It causes atrophy of the intestinal villi.
Presentation
Failure to thrive in young children
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia secondary to iron, B12 or folate deficiency
Dermatitis herpetiformis (an itchy blistering skin rash typically on the abdomen)
Genetic Associations
HLA-DQ2 gene (90%)
HLA-DQ8 gene
Auto-antibodies for coeliac
Tissue transglutaminase antibodies (anti-TTG)
Endomysial antibodies (EMAs)
Deaminated gliadin peptides antibodies (anti-DGPs)
Diagnosis
Investigations must be carried out whilst the patient remains on a diet containing gluten otherwise it may not be possible to detect antibodies or inflammation in the bowel.
Check total immunoglobulin A levels to exclude IgA deficiency before checking for coeliac disease-specific antibodies:
Raised anti-TTG antibodies (first choice)
Raised anti-endomysial antibodies
Endoscopy and intestinal biopsy show:
“Crypt hypertrophy”
“Villous atrophy”
conditions associated with coeliac
Type 1 Diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Complications of Untreated Coeliac Disease
Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL) of the intestine
Non-Hodgkin lymphoma (NHL)
Small bowel adenocarcinoma (rare)
How is coeliac treated ?
Lifelong gluten-free diet
