Coeliac

Question 1

What is it

Answer 1

Autoimmune –> dietary proteins, glutens, activate abnormal mucosal response with chronic inflammation + villous atrophy in small intestine.

Question 2

Who is affected

Answer 2

2:1 F>M

Question 3

What causes it

Answer 3

• genetic: HLA
• Fx
• DMT1
• Autoimmune thyroid disease

Question 4

What is the presentation

Answer 4

GI
- Indigestion, diarrhoea, abdo pain, bloating + constipation

Non- GI
- Fatigue, anaemia, dermatitis, oesteoporosis, delayed puberty, fertility problems

Unexplained weight loss + severe + persistent mouth ulcers

Question 5

How do you investigate

Answer 5

• Serology testing - IgA tissue transglutaminase antibody (tTGA) or IgA endomysial antibody
• Have to ensure that person has eaten gluten-containing foods at least twice a day for a period of 6 weeks.

Question 6

How do you manage it

Answer 6

High dose folic acid supplements

Assess complications
Consider annual blood testing: coeliac serology, FBC, ferritin, TFTs, LFTs, vit D, vit B12, red cell folate, serum Ca, electrolytes (Addison’s disease)

Consider referral to dietician if struggling with gluten free diet.