Coeliac disease

Question 1

Clinical features in childhood:

Answer 1

usually presents at 9–18 mths, but any age

previously thriving infant

anorexia, lethargy, irritability

failure to thrive

malabsorption: abdominal distension

offensive frequent stools

Note: Coeliac disease can occur at any age.

Question 2

Diagnosis:

Answer 2

characteristic duodenal biopsy—villous atrophy (gold standard test)

IgA markers

serum antigliadin (limited value), anti-endomysial and transglutaminase Abs—90% sensitivity and specificity

Question 3

Classic triad:

Answer 3

diarrhoea, weight loss, iron deficiency.

Question 4

Treatment:

Answer 4

remove gluten from diet