coeliac

Question 1

what is coeliac disease?

Answer 1

autoimmune condition characterised by gluten insensitivity

Question 2

how much of the UK pop are affected by coeliac?

Answer 2

1% - most prevalent gastro condition in the UK

Question 3

who is mainly affected by coeliac?

Answer 3

women make up 2/3 of cases

Question 4

when are likely to get a coeliac diagnosis?

Answer 4

early infancy - first start weaning
large peak in 40-50yrs

Question 5

what is the aetiology of coeliac?

Answer 5

• Gliadin is a component of gluten and it is not fully broken down and passes through intestinal epithelial layer triggering immune response
• Gliadin binds to HLA DQ2 or DQ8 which activated T cells in mucisa
• Leads to immune response causing chronic inflammation
• This damages epithelium and results in malabsorption

Question 6

what are risk factors for coeliac?

Answer 6

• Genetics
• Autoimmune thyroid disease
• Type 1 DM
• IgA deficiency

Question 7

what are symptoms of coeliac?

Answer 7

• Long standing diarrhoea
• Nausea and vomiting
• Fatigue
• Weight loss

Question 8

what conditions are associated with coeliac?

Answer 8

: I Don’t Take Apple, I Take Oranges
- IgA deficiency
- Downs syndrome
- Turner syndrome
- Autoimmune thyroid and autoimmune hepatitis
- IgA nephropathy
- Type 1 DM
- Other autoimmune conditions

Question 9

what are clinical signs of coeliac?

Answer 9

• Anaemia
• Mouth ulcers
• Weight loss (may not be significant)
• Anxiety
• Joint pain
• Abdo pain
• Dermatitis herpetiformis

Question 10

what are the lab tests used to diagnose coeliac?

Answer 10

TTG antibodies and total IgA
- IgG endomyosial antibodies, IgG deaminated gliadin peptide (DBP)
- Genetic HLA DQ2

Question 11

what would a biopsy for coeliac indicate?

Answer 11

• Villous atrophy leading to flat mucosa – normalises after gluten has been removed
• Crypt cell hyperplasia
• Intraepithelial cell lymphocytosis
• Inflame cell infiltration of lamina propria

Question 12

what are differentials for coeliac?

Answer 12

• Anorexia
• Bacterial overgrowth of small bowel
• Chrons disease
• Irritable bowel syndrome
• Lactose intolerance
• Autoimmune enteropathy

Question 13

what management is required for coeliac?

Answer 13

• Life long gluten free diet – foods containing gluten rye, wheat, barley and oats
• Immunisations: individuals with coeliac often have functional hyposplenism – defective immune response and pneumococcal vaccines every 5 years
• Annual follow up

Question 14

what are long term complications of coeliac disease?

Answer 14

• Hyposplenism
• Iron deficiency anaemia
• Malnutrition
• Osteoporosis
• Small bowel T cell lymphoma
• Vit B12 and folate deficiency