Coeliac Disease Flashcards
What is coeliac disease?
AI condition where exposure to gluten leads to autoimmune reaction where auto-antibodies form and target the epithelial cells of intestine (jejunum especially)
Leads to villous atrophy and crypt hypertrophy
How might someone with coeliac disease present?
Failure to thrive in young children
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia due to malabsorption of iron, B12 and folate
Dermatitis herpetiformis= blistering itchy rash on abdomen
Other AI conditions i.e. type 1 diabetes
(All new cases of type 1 diabetes are tested for coeliac)
Which genes are associated with coeliac?
HLA-DQ2
HLA-DQ8
Which auto-antibodies are associated with coeliac disease?
Why should you test for total Ig levels with measure for these autoantibodies?
Tissue transglutaminase antibodies (anti-TTG)
Endomysial antibodies (EMAs)
Deaminated gliadin peptides antibodies (anti-DGPs)
Anti-TTG and EMA are both IgA antibodies meaning if the patient has IgA deficiency, the coeliac test might be negative
What investigations are done when someone is suspected to have coeliac?
NOTE:
-all investigations must be carried out whilst patient remains on diet containing gluten
FBC= seen if anaemic due to deficiencies
Total IgA levels
Anti-TTG
Anti-EMAs
Endoscopy if autoantibodies raised:
- crypt hypertrophy
- villous atrophy
What autoimmune conditions is coeliac associated with?
Type 1 diabetes
Thyroid disease
Autoimmune hepatitis
PBC
PSC
What complications can occur if coeliac disease is left untreated?
Vitamin deficiency
Anaemia
Osteoporosis i.e. decreased calcium absorption leads to increased PTH release which increases osteoclast activity to release calcium from bones
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma
Non-hodgkin lymphoma (NHL)
Small bowel adenocarcinoma
What is the treatment for coeliac disease?
Lifelong gluten-free diet
