Coeliac Disease Flashcards
What is coeliac disease?
Intolerance to gluten (gliadin in particular), found in wheat/barley/rye.
What is the aetiology of coeliac disease?
Gliadin triggers inappropriate activation of intestinal T-cells in genetically susceptible individuals (HLA-DQ2/8) resulting in damage to intestinal epithelial cells.
What is the end result of coeliac pathophysiology?
Loss of normal small bowel function and malabsorption.
Which age group is commonly affected by coeliac disease and what are the risk factors?
- Peaks in childhood and 50-60 years.
2. FHx, IgA deficiency, T1DM, autoimmune thyroid disease.
What is this a presentation of and what is the rash called?
Steatorrhoea, diarrhoea, abdominal pain, bloating, nausea and vomiting, angular stomatitis, iron deficiency anaemia, weight loss, fatigue, weakness, osteomalacia, failure to thrive in children, very itchy and blistering rash over elbows and buttocks.
- Coeliac disease
2. Dermatitis herpetiformis
How is coeliac disease diagnosed and investigated?
- FBC shows iron deficiency anaemia
- On gluten containing diet: IgA-tTG, check total IgA to exclude deficiency.
- If IgA deficient - deaminated gliadin peptide
- IgA Endomysial Ab if IgA-tTG unavailable
- If IgA-tTG elevated - duodenal biopsy while on gluten containing diet.
What histology is seen on a duodenal biopsy in coeliac disease?
Subtotal villous atrophy. increased intra-epithelial lymphocytes and crypt hyperplasia.
What is the treatment for coeliac disease?
- Lifelong gluten free diet
- Monitor response by symptoms ad repeated serology
- Calcium and vitamin D supplements (+ DEXA)
- Iron if iron deficient
What are the complications of coeliac disease and what causes them?
- Anaemia - malabsorption of folic acid
- Dermatitis herpetiformis
- Osteopenia, osteoporosis - malabsorption of calcium, vitamin D (baseline DEXA at diagnosis)
- Hyposplenism
- Increased risk of malignancy
