Coeliac Disease Flashcards
Coeliac disease is a … condition where exposure to … leads to an … reaction leading to inflammation in the …
Coeliac disease is a autoimmune condition where exposure to gluten leads to an immune reaction leading to inflammation in the small bowel
In coeliac disease, autoantibodies are created in response to exposure to gluten - these target the epithelial cells of the intestine causing inflammation - what are these two autoantibodies ?
Anti-tissue transglutaminase (anti-TTG)
Anti-endomysial (anti-EMA)
What area is particularly affected in coeliac disease?
Small bowel - Jejunum - causes atrophy of intestinal villi - inflammation leading to malabsorption - symptoms of disease
Coeliac disease leads to atrophy of intestinal villi - inflammation leading to … - symptoms of disease
Malabsorption
Presentation of coeliac disease
Often asymptomatic Failure to thrive Diarrhoea Fatigue Weight loss Mouth ulcers Anaemia - deficiency of iron, B12, folate Dermatitis herpetiformis - itchy, blistering rash in abdomen
Dermatitis herpetiformis - itchy, blistering rash in abdomen - manifestation of …
Coeliac disease (about 10% get the rash)
Rarely, coeliac disease presents with neurological symptoms such as:
Peripheral neuropathy
Cerebella ataxia
Epilepsy
Test all new cases of … for coeliac disease as the conditions are often linked
T1 DM
Genes associated with Coeliac: (2)
HLA-DQ2 - most common
HLA - DQ8
3 autoantibodies associated with coeliac:
ANTI-TTG
ANTI-EMA
- These are IgA antibodies - some patients have a IgA deficiency - test total immunoglobulin A - as patient may have low anti-TTG and low anti-EMA but have coeliac still!
ANTI-DGP (less common in exam+ real life)
As patients with coeliac disease may have an IgA deficiency, it is important to test for the total immunoglobulin A - explain why
Anti-TTG and anti-EMA - two autoantibodies involved in coeliac - are both IgA antibodies
If the patient is IgA deficient, these autoantibodies may be low - but the patient may still have coeliac disease! (False negative test)
Test IgA low, test IgG version of anti-TTG and anti-EMA or do an endoscopy and biopsy to confirm the result
Diagnosis of coeliac disease: Important to do the investigations when the patient is still … Test for total … Which autoantibodies? What other investigations can be done?
Investigations while diet contains gluten - as may not detect antibodies
Total IgA - exclude deficiency
Anti-TTG or Anti-EMA
Endoscopy + Intestinal biopsy - classic signs of crypt hypertrophy and villous atrophy
Classic signs on endoscopy + intestinal biopsy of coeliac disease
Endoscopy + Intestinal biopsy - classic signs of crypt hypertrophy and villous atrophy
Associations with coeliac disease:
T1 DM Thyroid disease Autoimmmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis
Complications if coeliac is untreated:
Vitamin deficiency Anaemia Osteoporosis Ulcerative jejunitis Enteropathy-associated T-cell lymphoma (EATL) Non-Hodgkin lymphoma Small bowel adenocarcinoma
