Coeliac disease

Question 1

What is coeliac disease?

Answer 1

Inflammatory disease caused by intolerance to GLUTEN, causing chronic intestinal malabsorption.
Leads to subtotal villous atrophy + crypt hyperplasia

Question 2

Give 2 epidemiological facts about coeliac disease

Answer 2

1/ 100 in UK
Only 10-20% diagnosed

Question 3

Describe the pathophysiology of coeliac disease

Answer 3

Due to sensitivity to the GLIADIN component of gluten
Exposure to gliadin triggers immunological reaction in the small intestine leading to mucosal damage + loss of villi
Leads to malabsorption

Question 4

Which conditions are associated with coeliac disease?

Answer 4

Dermatitis herpetiformis
AI disease: T1DM, AI hepatitis

Question 5

Describe the HLA associations seen in coeliac disease

Answer 5

HLA-DQ2 (95% of patients)
HLA-DQ8 (80%).

Question 6

Patients with which 5 conditions should be screened for coeliac?

Answer 6

AI Thyroid disease
Dermatitis herpetiformis
IBS
T1DM
1st degree relatives with coeliac

Question 7

List 7 S/S that indicate coeliac screening should be performed

Answer 7

Chronic/ intermittent diarrhoea
FTT or faltering growth (in children)
Persistent or unexplained GI Sx inc. N+V
Prolonged fatigue (‘TATT’)
Recurrent abdo pain, cramping or distension
Sudden/ unexpected weight loss
Unexplained IDA, or other unspecified anaemia

Question 8

List 4 symptoms of coeliac disease

Answer 8

Abdo discomfort, pain + distention
Diarrhoea/ steatorrhoea
Tiredness, malaise
WL (despite normal diet)

Question 9

List 4 signs of coeliac on examination

Answer 9

Anaemia: pallor
Malnutrition: Short stature, abdo distension, wasted buttocks
Vitamin/mineral deficiencies: osteomalacia, easy bruising
Amenorrhoea in young adults

Question 10

Prior to testing in suspected Coeliac, what must be checked?

Answer 10

Ensure have eaten gluten-containing foods in >,1 meal a day, for minimum 6w, before testing performed

Question 11

What are the first line tests for coeliac disease?

Answer 11

Anti-Tissue transglutaminase (TTG) antibodies (IgA)
Total IgA

Question 12

Why must total IgA be measured when testing for coeliac?

Answer 12

Selective IgA deficiency would give a false negative coeliac result

Question 13

What is the gold standard investigation to confirm diagnosis of coeliac disease?

Answer 13

Endoscopic intestinal biopsy
Duodenal (sometimes jejunal biopsies)

Question 14

What will biopsy show in coeliac disease?

Answer 14

Villous atrophy
Crypt hyperplasia
Increase in intraepithelial lymphocytes
Lamina propria infiltration with lymphocytes

Question 15

Describe management of coeliac disease

Answer 15

GF diet
Pneumococcal vaccination + booster every 5y (due to functional hyposplenism)
Annual bloods
+/- refer to dietician

Question 16

What can be checked to monitor compliance with GF diet?

Answer 16

Tissue transglutaminase antibodies

Question 17

List 6 complications of coeliac disease

Answer 17

Anaemia: Iron, FOLATE + B12 deficiency
Hyposplenism
Osteoporosis, Osteomalacia
Lactose intolerance
Enteropathy associated T cell lymphoma of small intestine
Sub-fertility

Question 18

Describe the prognosis in coeliac disease

Answer 18

FULL RECOVERY in most patients who strictly adhere to a GF diet
Sx usually resolve within weeks though histological changes may take longer
GF diet must be followed for life