Coeliac Disease Flashcards
What is coeliac disease?
Coeliac disease is an autoimmune condition where exposure to gluten causes an autoimmune reaction that targets epithelial cells in the intestine and causes inflammation in the small bowel.
When does coeliac disease usually develop?
It usually develops in early childhood but can start at any age.
What two auto-immune antibodies are involved?
anti-tissue transglutaminase (anti-TTG) and anti-endomysial (anti-EMA), and deaminated gliadin peptides antibodies (anti-DGPs). They relate to disease activity and will rise with more active disease and may disappear with effective treatment.
What will the endoscopy and intestinal biopsy show in coeliac disease?
Villous atrophy and crypt hypertrophy
What effect do villous atrophy and crypt hypertrophy have on digestion?
The intestinal cells have villi on them that help with absorbing nutrients from the food passing through the intestine. The inflammation causes malabsorption of nutrients and the symptoms of the disease.
What symptoms does coeliac disease present with?
Failure to thrive in young children
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia secondary to iron, B12 or folate deficiency
Dermatitis herpetiformis (an itchy blistering skin rash typically on the abdomen)
Peripheral neuropathy
What rare neurological symptoms can be present in coeliac disease?
Peripheral neuropathy (damage to nerves in the peripheries)
Cerebellar ataxia
Epilepsy
What condition do they test all new cases of for coeliac disease?
Type 1 diabetes -> the conditions are often linked
What genes are associated with the condition?
HLA-DQ2 gene (90%)
HLA-DQ8 gene
Why is it important to test for total immunoglobulin A levels not just IgA?
Anti-TTG and anti-EMA antibodies are IgA. Some patients have an IgA deficiency. When you test for these antibodies, it is important to test for total Immunoglobulin A levels because if total IgA is low because they have an IgA deficiency then the coeliac test will be negative even when they have coeliacs. In this circumstance, you can test for the IgG version of anti-TTG or anti-EMA antibodies or simply do an endoscopy with biopsies.
Why is it important that diagnostic tests are carried out whilst the patient remains on a diet containing gluten?
Because otherwise, it may not be possible to detect antibodies or inflammation in the bowel
What other conditions is coeliac disease is associated with many other autoimmune conditions?
Type 1 diabetes, thyroid disease, autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis.
What are some complications of untreated coeliac diseasE?
Vitamin deficiency Anaemia
Osteoporosis
Ulcerative jejunitis, Enteropathy-associate T-cell lymphoma (EATL) of the intestine,
Non-Hodgkin lymphoma, Small bowel adenocarcinoma (rare)
What complications can occur in coeliac disease in pregnancy?
Poorly controlled coeliac disease in pregnancy can increase the risk of developing pregnancy-related complications, such as giving birth to a baby with a low birth weight.
What is the follow-up procedure in patients with coeliac disease?
They should be followed up annually reviewing weight, height, ongoing symptoms, and the need for dietetic input.
In those with ongoing symptoms, IgA tTG measurements can be carried out to check for compliance with a gluten-free diet. Adults with well-controlled disease may be followed up less frequently.14
