Coeliac disease Flashcards

1
Q

Aetiology of coeliac disease

A

Coeliac disease is an autoimmune condition caused by sensitivity to the protein gluten.

It is thought to affect around 1% of the UK population.

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2
Q

Pathophysiology of coeliac disease

A
  • repeated exposure to the protein gluten leads to villous atrophy which in turn causes malabsorption
  • strongly associated with HLA-DQ2 and KLA-DQ8
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3
Q

Conditions associated wit coeliac disease?

A

Dermatitis herpetiformis (a vesicular, pruritic skin eruption)

Autoimmune disorders Type 1 DM and autoimmune hepatitis

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4
Q

Clinical presentation: coeliac disease

A

In adult patients, remember that typical symptoms of malabsorption and diarrhoea may not occur and many diagnoses are formed on the findings of vague symptoms with or without iron-deficiency anaemia.

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5
Q

Investigations for the diagnosis of coeliac disease

A

Serology

  • tissue transglutaminase (TTG) antibodies (IgA) are first-choiceaccording to NICE
  • endomyseal antibody (IgA)
    • needed to look for selective IgA deficiency, which would give a false negative coeliac result
  • anti-gliadin antibody (IgA or IgG) tests are not recommended by NICE
  • anti-casein antibodies are also found in some patients

Endoscopic intestinal biopsy

  • the ‘gold standard’ for diagnosis - this should be performed in all patients with suspected coeliac disease to confirm or exclude the diagnosis
  • traditionally done in the duodenum but jejunal biopsies are also sometimes performed
  • findings supportive of coeliac disease:
    • villous atrophy
    • crypt hyperplasia
    • increase in intraepithelial lymphocytes
    • lamina propria infiltration with lymphocytes
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6
Q

important to remember for testing of coeliac disease

A

If patients are already taking a gluten-free diet they should be asked, if possible, to reintroduce gluten for at least 6 weeks prior to testing.

this is for both endoscopy and assessing coeliac antibodies

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7
Q

Complications of coeliac disease

A

anaemia: iron, folate and B12 deficiency (folate more common than B12 deficiency in coeliac disease)

hyposplenism

osteoporosis, osteomalacia

lactose intolerance

enteropathy-associated T-cel lymphoma of small intestine

subfertility, unfavourable pregnancy outcomes

rare: oesophageal cancer, other malignancies

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