Coeliac disease Flashcards
Aetiology of coeliac disease
Coeliac disease is an autoimmune condition caused by sensitivity to the protein gluten.
It is thought to affect around 1% of the UK population.
Pathophysiology of coeliac disease
- repeated exposure to the protein gluten leads to villous atrophy which in turn causes malabsorption
- strongly associated with HLA-DQ2 and KLA-DQ8
Conditions associated wit coeliac disease?
Dermatitis herpetiformis (a vesicular, pruritic skin eruption)
Autoimmune disorders Type 1 DM and autoimmune hepatitis
Clinical presentation: coeliac disease
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.
Investigations for the diagnosis of coeliac disease
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
important to remember for testing of coeliac disease
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
Complications of coeliac disease
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