Coeliac Disease

Question 1

What is Coeliac Disease?

Answer 1

• It is the most common genetically related food intolerance
• It is a life long gluten sensitive autoimmune disease

Question 2

What is the Pathophysiology of Coeliac Disease?

Answer 2

• Immunological response to the environmental factor of gliadin
• Genetic factors (HLA-DQ2/DQ8)
• Viral Infections + Gut bacteria play a role
• Immune Mechanisms: - Body’s immune system overreacts to gluten, damages the villi. Villi absorb vitamins, minerals and nutrients therefore you experience malabsorption.
• T-cell mediated immune disorder = epithelial cell destruction and villous atrophy

Question 3

What are the Risk Factors for Coeliac Disease/

Answer 3

• Gliadin Fraction: Rye, Wheat and Barley

Question 4

What is the clinical Presentation of Coeliac Disease?

Answer 4

• Coeliac Disease if often asymptomatic
• Failure to thrive
• Diarrhoea
• Weight loss
• Fatigue
• Anaemia secondary to iron, b12 or folate deficiency
• Dermatitis Herpetiformis
• Mouth Ulcers

Question 5

What are the Neurological Symptoms of Coeliac Disease?

Answer 5

• Peripheral Neuropathy
• Cerebellar Ataxia
• Epilepsy

Question 6

What are the genetic associations?

Answer 6

• HLA - DQ2
• HLA - DQ8

Question 7

What are the auto- antibodies associated with Coeliac Disease?

Answer 7

• anti- tissue transglutaminase antibodies
• anti- endomysial antibodies
• Ensure with the two antibodies above you are testing IgA antibodies to ensure there is no IgA deficiency
• anti- deaminated gliadin peptides antibodies

Question 8

What do you do if the patient has an IgA deficiency?

Answer 8

• Test for the IgG version of the anti- tissue transglutaminase and anti- endomysial or do an endoscopy with biopsies

Question 9

What are the typical findings on biopsy in children?

Answer 9

• Crypt Hyperplasia and Villous Atrophy

Question 10

What investigation would you do for suspected coeliac disease?

Answer 10

1. Serology Testing:
   - This requires the patient to have gluten in their diet at the period of testing and for at least 6 weeks before testing
   - Test for IgA and IgA tissue transglutaminase and IgA endomysial
   - If IgA deficient then consider IgG TTG and IgG EMA
   - Consider Genetic testing in people who choose not to re start gluten
   - If serology is positive:
2. Biopsy
   - GOLD STANDARD: Duodenal Biopsy
   - Marsh Classification

Question 11

What is the Managment for Coeliac Disease?

Answer 11

• Lifelong diet free of Gluten
• Diet supplements for malabsorption
• Patients should have an annual follow up to check symptoms, diet and development

Question 12

What can you have on a gluten free diet?

Answer 12

• Dairy products, cheese, butter and milk
• Fruit and Vegetables
• Meat and Fish
• Potatoes
• Gluten- free flours

Question 13

What are the complications of Coeliac Disease?

Answer 13

• Anaemia
• Osteoporosis/ osteopenia
• Fertility
• Enteropathy-associated T cell lymphoma
• Non-hodgkin Lymphoma
• Small bowel adenocarcinoma
• Depression/ Anxiety

Question 14

What is associated with Coeliac disease?

Answer 14

• Type 1 diabetes
• Thyroid disease
• Primary biliary Cirrhosis
• Primary Sclerosing Cholangitis
• Autoimmune hepatitis