coeliac disease

Question 1

how to investigate suspected coeliac?

Answer 1

Diagnosis is made by a combination of serology and endoscopic intestinal biopsy. Villous atrophy and immunology normally reverses on a gluten-free diet.

Question 2

how long before testing should coeliac patients reintroduce gluten if they have been on a gluten free diet?

Answer 2

at least 6 weeks prior to testing.

Question 3

what serology tests would you do?

Answer 3

• tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
• endomyseal antibody (IgA)

but need to look for IGA deficiency, as this may result in a false negative result

Question 4

what is the gold standard for coeliac disease diagnosis?

Answer 4

endoscopic intestinal biopsy

findings supportive of coeliac disease:
villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes