Coeliac disease

Question 1

What is coeliac disease, and what causes it?

Answer 1

Autoimmune condition where exposure to gluten causes an autoimmune reaction that causes inflammation in the small bowel

Question 2

What do the auto-antibodies created in response to exposure to gluten target in coeliac disease?

Answer 2

Epithelial cells of the intestine

Question 3

1) What are the 2 main auto-antibodies?
2) Which of these is the main one?
3) What kind of immunoglobulins are these?
4) What should be done before checking for these autoantibodies?

Answer 3

1) Anti-tissue transglutaminase (anti-TTG) and anti-endomysial (anti-EMA)
2) Anti-tissue transglutaminase
3) IgA
4) Check for IgA deficiency

Question 4

1) Which part of the small bowel does the inflammation particular effect?
2) What is the consequence of the inflammation?

Answer 4

1) Jejunum
2) Atrophy of the intestinal villi and crypt hyperplasia which causes malabsorption of nutrients and consequently the symptoms of the disease

Question 5

Name 2 signs/symptoms of coeliac disease

Answer 5

• Abdo pain, bloating, cramping, distention
• Failure to thrive in young children
• Diarrhoea
• Fatigue
• Weight loss
• Anaemia secondary to iron, B12 or folate deficiency
• Dermatitis herpetiformis (an itchy blistering skin rash typically on the abdomen)

Question 6

What gene is associated with over 90% of cases?

Answer 6

HLA-DQ2 gene

Question 7

What is important to ensure when investigations are being carried out?

Answer 7

Patient stays on gluten diet for 6 week

Question 8

What are the 2 main things an endoscopy in a patient with coeliac disease will show?

Answer 8

Crypt hypertrophy and villous atrophy

Question 9

Name an autoimmune disease that coeliac disease is associated with

Answer 9

• Type 1 Diabetes
• Thyroid disease
• Autoimmune hepatitis
• Primary biliary cirrhosis
• Primary sclerosing cholangitis

Question 10

Name 2 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)

Question 11

How is it managed?

Answer 11

Lifelong gluten-free diet

Question 12

1) Why do patients with coeliac disease require regular immunisations?
2) What immunisation is offered to patients with coeliac disease (and a booster every 5 years)?
3) How often do patients with coeliac disease require blood tests?

Answer 12

1) Patients with coeliac disease often have a degree of functional hyposplenism
2) Pneumococcal
3) Annually