Coeliac

Question 1

Coeliac Indications for Testing

Answer 1

Test those with

• Persistent unexplained GI symptoms
• Faltering growth
• Prolonged fatigue
• Unexpected weight loss
• Mouth ulcers
• Unexplained deficiencies
• Those with other autoimmune disorders
• FHx

Question 2

Coeliac Presentation

Answer 2

• Wide variation in symptoms and signs
• Many cases are asymptomatic

Neurological presentation
-Cerebellar ataxia, peripheral neuropathy, epilepsy, dementia, depression

Question 3

Coeliac Ix

Answer 3

• Do not start gluten free diet until confirmed
• Refer if unwilling
• tTGA2, EMAs if negative
• Total IgA tTG, IgA EMA if IgA tTG is weakly positive
• Use IgG EMA or IgG tTG if IgA deficient
• FBCs; anaemia and folate deficiency common
• LFTs
• Biopsy needed to confirm villous atrophy

Question 4

Coeliac Differentials

Answer 4

• IBS
• Food intolerance e.g. lactose
• IBD

Question 5

Coeliac Management

Answer 5

• Gluten free diet

- Provide information

Question 6

Coeliac Complications

Answer 6

• Nutrient deficiencies
• Osteoporosis
• Cancer risk
• Ulcerative jejunitis
• Functional hyposplenism