Coeliac

Question 1

What is the pathology in Coeliac Disease?

Answer 1

Enteropathy - gliadin fraction of gluten provokes damaging immunological response in proximal small intestinal mucosa.

As a result, rate of migration of absorptive cells moving up villi (enterocytes) from crypts is massively increased, but is insufficient to compensate for increased cell loss from villous tips.

Villi become progressively shorter and then absent, leaving flat mucosa.

Question 2

When are children likely to present with coeliac?

Answer 2

Less acutely in later childhood

Question 3

What is the classical presentation of Coeliac disease?

Answer 3

• Profound malabsorptive syndrome at 8-24 months after introduction of wheat-containing foods
• Failure to gain weight
• Buttock wasting
• Abdo distension
• Abnormal stools
• General irritability

Can present with:
• Mild, non-specific GI symptoms
• Anaemia (iron &/or folate deficiency)
• Growth failure

Question 4

What is the screening test for Coeliac disease?

Answer 4

IgA tissue transglutaminase antibodies and endomysial antibodies.

Question 5

On what does diagnosis depend in Coeliac?

Answer 5

Demonstration of mucosal changes:
• Increased intraepithelial lymphocytes
• Variable degree of villous atrophy
• Crypt hypertrophy

Question 6

What is the management of Coeliac?

Answer 6

Remove wheat, rye and barley from diet.