Coeliac disease

Question 1

What is Coeliac disease?

Answer 1

This is a condition caused by an autoimmune reaction to gluten, which damages enterocytes and reduces absorptive capacity

Question 2

Describe the pathophysiology of Coeliac disease

Answer 2

Gliadin, a component of gluten, stimulates an immunological reaction, causing activation of abnormal T cells, causing loss of villous structures, therefore causing a loss of surface area, and a reduction in absorption

Question 3

What are the 2 main antibodies found in Coeliac disease?

Answer 3

Anti-tissue transglutaminase (Anti-TTG)
Anti-endomysial (Anti-EMA)
These are both mainly IgA Antibodies

Question 4

What are the 2 most common genetic mutations in Coeliac disease?

Answer 4

HLA-DQ8
HLA-DQ2

Question 5

What are some conditions associated with Coeliac disease?

Answer 5

Dermatitis herpetiformis
Type I diabetes
Autoimmune hepetitis
Thyroid disease
Primary Sclerosing Cholangitis
Primary Biliary Cholangitis

Question 6

How is a diagnosis of coeliac disease made?

Answer 6

Total IgA count to exclude IgA deficiency
Raised Anti-TTG
Raised Anti-EMA
Raised Anti-gliadin
Colonoscopy

Question 7

What will be seen histologically in coeliac disease?

Answer 7

Villous atrophy
Crypt hypertrophy

Question 8

What is dermatitis herpetiformis?

Answer 8

An itchy blistering skin rash typically on the abdomen or elbows

Question 9

What are some rare neurological symptoms of Coeliac disease?

Answer 9

Peripheral neuropathy
Epilepsy
Cerebral ataxia

Question 10

What are some possible symptoms of Coeliac disease?

Answer 10

Intermittent diarrhoea
Nausea and vomiting
Failure to thrive in children
Chronic fatigue
Weight loss
Recurrent abdominal pain, cramping or bloating

Question 11

What are some consequences of Coeliac disease?

Answer 11

Anaemia - Fe, B12, Folate
Hyposplenism
Lactose intolerance
Enteropathy
T cell lymphoma
Increased risk of small bowel carcinoma
Gall stones
Ulcerative jejunoileitis

Question 12

What vitamins will a patient with Coeliac most commonly be deficient in?

Answer 12

Iron
Vitamin B12
Folate

Question 13

What disease will be tested for in all diabetes type I patients?

Answer 13

Coeliac disease

Question 14

How can coeliac disease cause gallstones?

Answer 14

Reduced intestinal hormone production lead to reduced pancreatic secretion and bile flow (CCK), therefore leading to cholestasis and thus, gallstones

Question 15

What is the main treatment option in Coeliac disease?

Answer 15

A gluten-free diet