Coeliac Disease Flashcards
What is coeliac disease?
systemic autoimmune disease triggered by dietary gluten peptides found in wheat, rye, barley, and related grains - GLIADIN
How common is coeliac disease?
affecting up to 1% of the general population, and may present at any age
What are the risk factors for coeliac disease?
- family history of coeliac disease
- immunoglobulin A deficiency
- type 1 diabetes
- autoimmune thyroid disease
What are the gastro symptoms of coeliac disease?
- Diarrhoea
- Bloating
- Stinky stools
- Abdominal pain/discomfort
What are the general symptoms for coeliac disease?
- IgA deficiency
- Anaemia
- family history
- Osteopenia/osteoperosis
- Fatigue
- Weight loss
- Failure to thrive
What are the potential differential diagnosis for coeliac disease?
- Peptic duodenitis
- Crohn’s disease
- Giardiasis
- Small-intestinal bacterial overgrowth
- Post-gastroenteritis
- Eosinophilic enteritis
- Tropical sprue
- Common variable immune deficiency (CVID) and other immunodeficiency states
- Graft-versus-host disease (GVHD)
- Autoimmune enteropathy
- Drug-induced enteropathy
- Non-coeliac gluten sensitivity
What bloods would you do for suspected coeliac disease?
- FBC and blood smear:
- immunoglobulin A-tissue transglutaminase (IgA-tTG):
- endomysial antibody (EMA):
- skin biopsy:
- IgG DGP (deamidated gliadin peptide) or IgA/IgG DGP
- IgG-tTG
What would the FBC and blood smear say in coeliac disease?
- low Hb
- microcytic hypochromic red cells
What would the IgA-tTG say in coeliac disease?
titre above normal range for laboratory
What would the EMA be like in coeliac disease?
elevated titre
What would the skin biopsy be like in coeliac disease?
granular deposits of IgA at the dermal papillae of lesional and perilesional skin by direct immunofluorescence
What would the IgG DGP and IgG-tTG show in coeliac disease?
elevated titre
What other tests would you run for suspected coeliac disease?
- Small bowel endoscopy
2. Small bowel histology
What would small bowel endoscopy show in coeliac disease?
- atrophy and scalloping of mucosal folds
- nodularity and mosaic pattern of mucosa
What would small bowel histology show in coeliac disease?
- presence of intra-epithelial lymphocytes
- villous atrophy
- crypt hyperplasia
What criteria is used for the histology in coeliac disease?
Marsh criteria
What is the 1st line treatment for coeliac disease?
gluten free diet
What else would you suggest for coeliac disease treatment?
vitamin and mineral supplementation
What is the 1st line treatment for coeliac disease that has failure to respond to therapy/refractory coeliac disease?
referral to dietician or gastroenterologist
How does coeliac crisis present?
- hypovolaemia
- severe watery diarrhoea
- acidosis
- hypocalcaemia
- hypoalbuminaemia
What is the first line treatment for a coeliac crisis and adjunct?
- 1st line: rehydration + correction of electrolyte abnormalities
- Adjunct: corticosteroid
What are the possible complications of coeliac disease?
- osteoperosis/osteopenia
- dermatitis herpetiformis
- malignancy
- idiopathic recurrent acute pancreatitis/ chronic pancreatitis
- pneumococcal infection
- non-response to hep B virus vaccine
What is the prognosis of coeliac disease like?
Good - Fewer than 1% of patients can be expected to develop refractory coeliac disease
What does coeliac disease result in histologically?
- Villous atrophy
- Hypertrophy of intestinal crypts
- Increased lymphocytes in epithelium and lamina propria
What is the epi of coeliac?
- F>M
2. Western countries
What is a skin condition assoicated with coleiac?
Dermatitis Herpetiformis
Where can you find Dermatitis Herpetiformis?
- extensor surfaces, face, scalp and neck
- elbows
- Description: bilateral itchy vesicles and plaques
