Coeliac disease

Question 1

Coeliac disease
- prevalence
- median age at diagnosis
- percentage of Australians undiagnosed

Answer 1

1.5% prevalence
40 years old
80% undiagnosed

Question 2

Coeliac disease associations

Answer 2

Many +++
Thyroid disease - 10% of those with coeliac disease
Osteoporosis / osteopaenia - 30% increase in fractures
T1DM, Addisons, Pernicious anaemia
Dermatitis herpeteformis

Question 3

Who to test for Coeliac disease (11)

Answer 3

GI symptoms, poor growth, fatigue, unexpected weight loss, mouth ulcers, unexplained iron, B12 or folate deficiency, T1DM or autoimmune thyroid disease, IBS, first degree relatives

Question 4

How to screen for coeliac disease

Answer 4

Option A: tTG-IgA + Total IgA level (most commonly recommended)
Option B: tTG-IgA + DGP-IgG
**2-3% of people with coeliac disease have a total IgA deficiency (which would result in falsely low tTG-IgA)
False negatives do occur, particularly if no longer consuming gluten

Question 5

Histology in Coeliac disease
- grading system used

Answer 5

Marsh score
Grade 0 - normal
Grade 1 - intraepithelial lymphocytes
Grade 2 - add crypt hyperplasia
Grade 3 - add villous atrophy

Question 6

What other diseases cause villous atrophy?

Answer 6

Infections - Tropical sprue, H. pylori, Giardia, SIBO
Immune - CVID, Crohn disease, cows milk protein intolerance, autoimmuneenteropathy
Medication - Olmesartan, NSAIDs, mycophenolate

Question 7

What HLA are associated with Coeliac disease?

Answer 7

HLA-DQ2.2
HLA-DQ2.8
HLA-DQ8

Question 8

What defines refractory disease?

Answer 8

Refractory coeliac disease is persistent or recurrent malabsorptive symptoms and signs with villous atrophy despite a gluten-free diet for more than 12 months

Question 9

What is the risk of developing non-hodgkin lymphoma?

Answer 9

3-6X relative risk

Question 10

Management of coeliac disease

Answer 10

Strict, life-long gluten free diet
Complication screening: TSH, LFTs, BGLs, DEXA
Nutrient assessment: Iron B12 Folate, Vit D, Mg, Zn
Family screening
Join Coeliac Australia
Ensure vaccination - higher rates of pneumococcal sepsis due to hyposplenism
Medical review - 4-6 monthly initially then annually once stable, in adults repeat gastroscopy and biopsy to assess / confirm mucosal remission