Coeliac Disease

Question 1

Destroyed enterocytes in bowel

No villi

Answer 1

Coeliac disease

Question 2

What is coeliac disease?

Answer 2

Autoimmune condition where exposure to gluten causes an immune reaction that creates inflammation in the small intestine

Question 3

Genetic associations of coeliac disease

Answer 3

HLA-DQ2 gene (90%)

HLA-DQ8 gene

Question 4

Clinical features of coeliac disease

Answer 4

Often asymptomatic

Failure to thrivein young children

Diarrhoea

Fatigue

Weight loss

Mouth ulcers

Anaemia secondary to iron, B12 or folate deficiency

Dermatitis herpetiformis

Question 5

Which antibodies are involved in coeliac disease?

Answer 5

Raisedanti-TTG antibodies(first choice)

Raisedanti-endomysial antibodies

Question 6

What do endoscopy and intestinal biopsy show in coeliac disease?

Answer 6

Crypt hypertrophy

Villous atrophy

Question 7

Why do coeliac investigations need to be performed when patient is still eating gluten?

Answer 7

Otherwise it may not be possible to detect the antibodies or inflammation in the bowel

Question 8

Associations of coeliac disease

Answer 8

T1DM

Thyroid disease

Autoimmune hepatitis

Primary biliary cirrhosis

Primary sclerosing cholangitis

Down’s syndrome

Question 9

Management of coeliac disease

Answer 9

Lifelong gluten free diet is essentially curative

Checking coeliac antibodies can be helpful in monitoring the disease

Question 10

Complications of untreated coeliac disease

Answer 10

Vitamin deficiency

Anaemia

Osteoporosis

Ulcerative jejunitis

Enteropathy-associated T-cell lymphoma (EATL) of the intestine

Non-Hodgkin lymphoma(NHL)

Small bowel adenocarcinoma (rare)