Coeliac disease

Question 1

Coeliac disease

Answer 1

Exposure to gluten causes autoimmune inflammation in the small bowel

Question 2

Auto-antibodies in coeliac disease

Answer 2

Anti-tissue transglutaminase

Anti-endomysial

Question 3

Histology

Answer 3

Villious atrophy

Crypt hyperplasia

Intraepithelial lymphocytosis

Question 4

Presentation

Answer 4

Failure to thrive in young children

Diarrhoea

Fatigue

Weight loss

Mouth ulcers

Anaemia secondary to iron, B12 or folate deficiency

Dermatitis herpetiformis

Question 5

Dermatitis herpetiformis

Answer 5

Itchy blistering skin rash typically on the abdomen

Question 6

Associated conditions

Answer 6

Autoimmune thyroid disease

Dermatitis herpetiformis

Irritable bowel syndrome

Type 1 diabetes

First degree relative with coeliac disease

Primary biliary cirrhosis

Primary sclerosing cholangitis

Question 7

Genetic associations

Answer 7

HLA-DQ2

HLA-DQ8

Question 8

Diagnosis

Answer 8

Investigations must be carried out while patient still on gluten diet

Check total immunoglobulin A levels to exclude IgA deficiency

Raise anti-TTG antibodies

Raised anti-endomysial antibodies

Question 9

Complications

Answer 9

Vitamin deficiency

Anaemia

Osteoporosis

Ulcerative jejunitis

Enteropathy-associated T cell lymphoma of the intestine

Non-Hodgkin lymphoma

Small bowel adenocarinoma

Question 10

Treatment

Answer 10

Lifelong gluten-free diet