Coeliac disease

Question 1

What is coeliac disease?

Answer 1

Coeliac disease: systemic autoimmune dis triggered by dietary gluten peptides found in wheat, rye, barley, etc.

Immune activation in small intestine→ villous atrophy, hypertrophy of intestinal crypts, and increased lymphocytes in epithelium and lamina propria.

Local changes lead to GI symptoms and malabsorption.
Systemic manifestations→ diverse, potentially affect many organs.

Question 2

Aetiology of coeliac disease?

Answer 2

Key genetic factor: HLA-DQ2/ HLA-DQ8 (but not all w gene develop disease)

Other factors hypothesised:
- Timing of initial gluten exposure
- GI infections
- Direct damage to intestinal-epithelial barrier

Question 3

Risk factors for coeliac disease?

Answer 3

Fam Hx
Ig A def
T1 diabetes
Autoimmune thyroid disease
Down’s syndrome

Weak:
- IBD
- Primary biliary cholangitis
- Psoriasis

Question 4

Signs and symptoms of coeliac disease?

Answer 4

• Diarrhoea
• Bloating
• Abdo pain/ discomfort (recurrent)
• Anaemia
• IgA def
• Osteopenia/ osteoporosis
• Fatigue
• Weight loss

Uncommon:
- Dermatitis herpetiformis
- T1 diabetes
- Easy bruising
- Peripheral neuropathy
- Ataxia

Question 5

Investigations for coeliac disease?

Answer 5

• Measure IgA and anti TTG IgA
  
  • IgA deficienct
  • Anti-TTG IgG→ positive
• Anti-EMA→ positive
• FBC: low HB, folate and B12 (macrocytic or microcytic)
• Albumin: low (acute phase protein = low in inflammation)
• Vitamin D: low
• Anaemia
• Phosphate
• CRP
• U&Es
• Endoscopy: OGD and duodenal biopsy = gold standard
  
  • Crypt hyperplasia and villous atrophy

Question 6

Management of coeliac disease?

Answer 6

• Avoid gluten
• Vitamin supplements
• May need to refer to dietician/ gastroenterologist
• Refer for DEXA scan (bone density scan)
• Dapsone (AB) for dermatitis hepetiformis

Question 7

What is a coeliac crisis?

Answer 7

• Rare
• Presents w hypovolaemia, severe watery diarrhoea, acidosis, hypocalcaemia, and hypoalbuminaemia.
• Patients may have a precipitating major medical event, e.g., recent abdominal surgery
• Require parenteral fluid replacement and nutritional support. Correct electrolyte abnormalities
• May benefit from short-course corticosteroids