Coeliac disease Flashcards
Define coeliac disease
Inflammatory disease caused by intolerance to GLUTEN, causing chronic intestinal malabsorption
Leads to subtotal villous atrophy & crypt hyperplasia
Aetiology of coeliac disease
4
Due to sensitivity to GLIADIN component of gluten
Exposure to gliadin triggers immunological reaction in small intestine —> mucosal damage & loss of villi
10% risk of 1st degree relative being affected
Clear genetic susceptibility associated w/ HLA-B8, HLA-DR3, HLA-DQW2 haplotypes
Epidemiology of coeliac disease
UK, rare
1/2000 in UK
Rare in East Asia
Presenting symptoms of coeliac disease
general +6
May be asymptomatic
Abdo discomfort, pain & distention
Steatorrhoea - pale bulky stool, offensive smell & difficult to flush
Diarrhoea
Tiredness, malaise, weight loss (despite normal diet)
Failure to thrive in children
Amenorrhoea in young adults
Signs of coeliac disease on physical examination
1, 4, 2, 1
Signs of anaemia
- pallor
Signs of malnutrition
- short stature
- abdo distention
- wasted buttocks in children
- triceps skin fold thickness give indication of fat stores
Signs of vitamin/mineral deficiencies
- osteomalacia
- easy bruising
Intense itchy blisters on elbows, knees or buttock (dermatitis herpetiformis)
Investigations for coeliac disease
5
Bloods Serology Stool D-xylose test Endoscopy
Investigations for coeliac disease - bloods
5
FBC - low Hb, iron & folate U&Es Albumin Calcium Phosphate
Investigations for coeliac disease - serology
2
IgG anti-gliadin antibodies, IgA & IgG anti-endomysial transglutaminase can be diagnostic
IgA deficiency quite COMMON (1/50 with coeliac) so Ig levels should be measured to avoid false negatives
Investigations for coeliac disease - stool
Culture to exclude infection, faecal fat tests for steatorrhoea
Investigations for coeliac disease - d-xylose test
Reduced urinary excretion after oral xylose indicates small bowel malabsorption
Investigations for coeliac disease - endoscopy
3
Allows direct visualisation of villous atrophy in small intestine (mucosa appears flat & smooth)
Biopsy shows villous atrophy & crypt hyperplasia in duodenum
Epithelium has cuboidal appearance - inflammatory infiltrate of lymphocytes in lamina propria
Management of coeliac disease
advice + 2 medical
ADVICE - Avoid gluten (wheat, rye, barley products)
MEDICAL -
Vitamin & mineral supplements
Oral corticosteroids if disease does not subside w/ avoidance of gluten
Complications of coeliac disease
6
Iron, folate & B12 deficiency Osteomalacia Ulcerative jejunoileitis GI lymphoma (particularly T cell) Bacterial overgrown Cerebellar ataxia (rarely)
Prognosis of coeliac disease
2
FULL RECOVERY for most patients who adhere strictly to gluten free diet (for life)
Symptoms usually resolve in weeks but histological changes may take longer