COELIAC DISEASE Flashcards
3 MAIN SOURCES OF GLUTEN?
BARLEY, RYE AND WHEAT
TYPICAL SYMPTOMS OF COELIAC DISEASE?
DIARRHOEA, STOMACH PAIN, BLOATING, FARTING, INDIGESTION, CONSTIPATION
+ FATIGUE, UNINTENTIONAL WEIGHT LOSS, ITCHY RASH, INFERTILITY, PERIPHERAL NEUROPATHY, ATAXIA…
WHAT IS THE NAME OF THE ITCHY RASH THAT SOMETIMES ACCOMPANIES COELIAC DISEASE?
DERMATITIS HERPETIFORMIS
SHOULD ASYMPTOMATIC COELIAC DISEASE BE TREATED? WHY?
YES, BECAUSE EVEN IF THERE ARE NO SYMPTOMS THE COMPLICATIONS ARISING FROM DAMAGE TO INTESTINAL VILLI CAN STILL OCCUR (E.G. MALABSOPRTION)
WHAT IS THE MOST COMMON SYMPTOM OF COELIAC DISEASE?
DIARRHEA
STEATORRHEA?
STOOL CONTAINING ABNORMALLY HIGH AMOUNTS OF FAT; FOUL SMELLING, GREASY, DIFFICULT TO FLUSH
1 IN HOW MANY COELIAC PATIENTS HAVE DERMATITIS HERPETIFORMIS?
1/5
HOW IS COELIAC DISEASE DIFFERENT THAN OTHER AUTOIMMUNE DISEASES?
THE BODY ATTACKS ITSELF BUT IN RESPONSE TO GLIADIN INSIDE GLUTEN, WHILE MOST OTHER AUTOIMMUNE DISEASES LEAD TO BODY ATTACKING ITS OWN TISSUE WITHOUT OUT AN EXTERNAL STIMULANT
APART FROM BARLEY, RYE AND WHEAT WHAT ELSE CAN BE HARMFUL FOR PEOPLE WITH COELIAC DISEASE IN MORE SEVERE CASES AND WHY?
OATS, BECAUSE THEY CONTAIN A PROTEIN AVENIN WHICH IS SIMILAR TO GLUTEN
RISK OF COELIAC DISEASE IF YOU HAVE FAMILY HISTORY OF IT?
10%
IF YOU HAVE AN IDENTICAL TWIN WITH COELIAC, CHANCES YOU WILL DEVELOP IT ARE:
75%
MUTATIONS IN WHICH GENE ARE ASSOCIATED WITH COELIAC DISEASE?
HLA-DQ
HOW MANY PEOPLE IN THE GEN POP HAVE HLA-DQ GENE MUTATIONS?
1/3
ENVIRONMENTAL FACTORS IN EARLY CHILDHOOD THAT CAN INCREASE THE LIKELIHOOD OF DEVELOPING COELIAC:
- HAVING DIGESTIVE SYSTEM INFECTION (E.G. ROTAVIRUS)
- HAVING GLUTEN INTRODUCED TO DIET BEFORE TURNING 3 M.O.
- NOT BEING BREASTFED WHEN GLUTEN IS INTRODUCED IN DIET
HEALTH CONDITION THAT CAN INCREASE RISK OF DEVELOPING COELIAC (COMMON COMORBIDITIES):
T1D, THYROID CONDITIONS, ULCERATIVE COLITIS, NEUROLOGICAL DISORDERS LIKE EPILEPSY, DOWN’S, TURNER’S
AFTER PATIENTS WITH COELIAC SWITCH TO NO-GLUTEN DIET, IT CAN TAKE UP TO HOW LONG FOR THEIR GI TRACT TO HEAL?
2 YRS
IS GLUTEN ESSENTIAL IN DIET?
NO
IF A PERSON KEEPS EATING GLUTEN AFTER BEING DIAGNOSED WITH COELIAC, WHAT ARE SOME OF THE LONG TERM RISKS?
VERY UNPLEASANT INTESTINAL SYMPTOMS, CANCER, OSTEOPOROSIS, IRON DEFICIENCY ANEMIA, B12 ANEMIA…
MAX AMOUNT OF GLUTEN THAT FOOD LABELLED AS ‘GLUTEN FREE’ CAN CONTAIN:
20 PARTS PER MILLION (PPM)
GLUTEN SHOULDN’T BE GIVEN TO BABIES BEFORE THEY TURN:
6 MONTHS
GLUTEN CONTENT OF BREAST AND INFANT FORMULA MILK?
ALL ARE GLUTEN FREE
WHAT IS REFRACTORY COELIAC DISEASE?
RARE TYPE OF COELIAC WHERE THE SYMPTOMS PERSIST EVEN IF ONE’S DIET IS COMPLETELY GLUTEN FREE, REASONS ARE UNKNOWN
HOW MANY PEOPLE WITH COELIAC HAVE THE REFRACTORY TYPE OF THE DISEASE?
1/140
HOW MANY PEOPLE IN THE UK ARE AFFECTED BY COELIAC?
1%
WHICH SEX IS AFFECTED BY COELIAC MORE AND HOW MUCH MORE?
WOMEN, 3 TIMES MORE THAN MEN
MOST COMMON AGES OF DIGANOSIS OF COELIAC DISEASE:
EARLY CHILDHOOD (BEFORE 1 Y.O.) OR LATE ADULTHOOD (40-60!!!)
WHAT PERCENTAGE OF PEOPLE WITH COELIAC ARE SENSITIVE TO OATS AS WELL?
5%
TESTING FOR WHICH ANTIBODIES IS A VERY SENSITIVE AND SPECIFIC TESTS FOR DIAGNOSIS OF COELIAC?
ANTI-tTG (TISSUE TRANSGLUTAMINASE)
WHAT STIMULATES IMMUNE RESPONSE BY T LYMPHOCYTES IN COELIAC DISEASE?
TISSUE TRANSGLUTAMINASE (tTG) INSIDE OF ENTERIC CELLS DEAMIDATES GLUTAMINE IN GLIADIN, CONVERTING IT FRO A NEUTRAL TO A NEGATIVELY CHARGED MOLECULE, WHICH WILL STIMULATE THE T CELLS.
WHAT STIMULATES IMMUNE RESPONSE BY T LYMPHOCYTES IN COELIAC DISEASE?
TISSUE TRANSGLUTAMINASE (tTG) INSIDE OF ENTERIC CELLS DEAMIDATES GLUTAMINE IN GLIADIN, CONVERTING IT FRO A NEUTRAL TO A NEGATIVELY CHARGED MOLECULE, WHICH WILL STIMULATE THE T CELLS.
WHICH ANTIBODIES WILL USUALLY BE PRESENT IN PEOPLE WITH COELIAC WHEN THEY CONSUME GLUTEN?
ANTIGLIADIN ANTIBODIES, ANTI-tTG ANTIBODIES AND IgA ANTIBODIES TO SMOOTH MUSCLE ENDOMYSIUM
WHAT ARE SOME OF THE COMMON SUPPLEMENTATIONS THAT MIGHT BE REQUIRED FOR PATIENTS WITH COELIAC AFTER SWITCHING TO GF DIET?
B12, FOLATE, VIT D, IRON, ZINC, CALCIUM, Mg
HOW DOES THE NEED FOR CALCIUM IN PEOPLE WITH COELIAC COMPARE TO THAT OF PEOPLE WITHOUT COELIAC?
PEOPLE WITH COELIAC HAVE HIGHER REQUIREMENTS FOR CALCIUM (1000 mg per day compared to 700 in gen pop)
WHAT IS ONE OF THE FIRST CHANGES IN THE INTESTINE IN PEOPLE WITH COELIAC?
INCREASED NUMBER OF INTRAEPITHELIAL LYMPHOCYTES
WHAT PERCENTAGE OF PEOPLE WHO MEET DIAGNOSTIC CRITERIA FOR IBS DON’T HAVE A FORMAL DIAGNOSIS?
CCA 40%
WHAT IS THE PERCENTAGE OF PEOPLE WITH IBS (PREVALENCE INTERNATIONALLY)?
10-15%
DOMINANT POPULATION WITH IBS IN TERMS OF SEX AND AGE?
WOMEN
YOUNGER THAN 50 Y.O.
HOW IS IBS DEFINED ACCORDING TO THE ROME IV CRITERIA?
RECURRENT ABDOMINAL PAIN AT LEAST ONE DAY A WEEK IN THE LAST 3 MONTHS ASSOCIATED WITH AT LEAST TWO OF THE FOLLOWING:
- RELATED TO DEFECATION
- ASSOCIATED WITH CHANGE IN STOOL FREQUENCY
- ASSOCIATED WITH CHANGE IN STOOL FORM/APPEREANCE
MANAGEMENT STRATEGIES FOR IBS:
- EXCLUSION OF GAS PRODUCING FOODS
- LOW FODMAP DIET
- GLUTEN AND LACTOSE AVOIDANCE IN SOME CASES
- AVOIDANCE OF LARGE MEALS
- REGULAR MEAL PATTERN
- REDUCED INTAKE OF FAT, INSOLUBLE FIBRES, CAFFEINE
