Coeliac

Question 1

Define coeliac disease

Answer 1

Coeliac disease is a systemic autoimmune disease triggered by dietary gluten peptides found in wheat, rye, barley, and related grains.

Question 2

Explain the aetiology / risk factors of coeliac disease

Answer 2

> family history of coeliac disease
> immunoglobulin A deficiency
> type 1 diabetes
> autoimmune thyroid disease
> Down's syndrome
> Sjogren's syndrome
> inflammatory bowel disease
> primary biliary cirrhosis

Question 3

Summarise the epidemiology of coeliac disease

Answer 3

Coeliac disease is a common disorder in the US and in Europe. A relatively uniform prevalence has been found in many countries

Women are slightly more likely to be affected

Question 4

Recognise the signs and symptoms of coeliac disease

Answer 4

immunoglobulin (IgA) deficiency
diarrhoea
bloating
abdominal pain/discomfort
anaemia
osteopenia/osteoporosis
fatigue
weight loss
failure to thrive

Question 5

Identify appropriate investigations for coeliac disease and interpret the results

Answer 5

FBC and blood smear
immunoglobulin A-tissue transglutaminase (IgA-tTG)
endomysial antibody (EMA)
skin biopsy (granular deposits of IgA)
IgG DGP (deamidated gliadin peptide) or IgA/IgG DGP
IgG-tTG
small bowel - macroscopic (scalloping, nodularity and mosaic pattern of mucosa)
small bowel - histology (Intra epithelial lymphocytes, villous atrophy, crypt hyperplasia)

Question 6

Generate a management plan for coeliac disease

Answer 6

> Diet restriction (gluten)
> Calcium and Vit D supplements
> Referral to dietician
> Rehydration and correction of electrolyte abnormalities
> Corticosteroids

Question 7

Identify the possible complications of coeliac disease and its management

Answer 7

Osteoporosis
Dermatitis herpetiformis
Malignancy
Pancreatitis
Pneumococcal infection

Question 8

Summarise the prognosis for patients with coeliac disease

Answer 8

The prognosis for patients with coeliac disease is good