Coeliac disease

Question 1

Skin manifestation of coeliac disease?

Answer 1

Dermatitis herpetiformis

Question 2

Morphology and distribution of dermatitis herpetiformis?

Answer 2

Itchy blisters typically on elbows, knees, shoulders, buttocks

Question 3

How long do patients need to be eating a gluten-containing diet prior to testing?

Answer 3

minimum 6 weeks

Question 4

Diagnostic process for coeliac disease? (3)

Answer 4

IgA tissue transglutaminase antibodies and total IgA (first-line)
IgA endomysial antibody (second-line)
Endoscopic small bowel biopsy (villous atrophy)

Question 5

How should negative serology be interpreted?

Answer 5

Check for IgA deficiency; if deficient, check for specific IgG instead. If normal, coeliac disease unlikely

Question 6

Malignancies associated with unreated coeliac disease? (3)

Answer 6

Small bowel adenocarcinoma
Hodgkin’s and NH lymphoma
Pancreatic cancer

Question 7

Management of coeliac disease?

Answer 7

Adherence to a gluten free diet

Question 8

Which vaccinations are indicated for which complication of coeliac?

Answer 8

Influenza, meningococcal, pneumococcal

Hyposplenism

Question 9

Availability of gluten-free foods on NHS?

Answer 9

England- only bread and flour mixes

NI/Scot/Wales- additional staple foods available

Question 10

Peak incidence of coeliac disease?

Answer 10

5th decade (adults)
around 4 yrs (child)