Coeliac Disease

Question 1

What is coeliac disease?

Answer 1

Problem where small intestine becomes inflamed and nutrients aren’t absorbed - mediated by gluten

Question 2

What is gluten?

Answer 2

Protein found in wheat, barely, rye

Question 3

Symptoms of coeliac disease

Answer 3

Diarrhoea, bloating, abdominal pain & cramping, indigestion, constipation, tiredness, weight loss, rash, & nerve damage

Question 4

Aetiology of coeliac disease

Answer 4

Autoimmune (hypersensitivity of the immune system to gluten)

Question 5

Genetic Autoimmunity of Coeliac Disease

Answer 5

Different halotypes (set of DNA variations that are inherited together) - halotype that affects WBCs’ ability to decipher self & non-self cells causing immune response

Question 6

Immunopathogenesis of coeliac disease

Answer 6

Intestinal cells damages ( adaptive and innate immune system)

Question 7

First stage of autoimmune response in coeliac disease:

Answer 7

Increased permeability of gut

Question 8

Second stage of autoimmune response in coeliac disease:

Answer 8

Passage of gliandin peptides - apoptosis of enterocytes

Question 9

Third stage of autoimmune response in coeliac disease:

Answer 9

Gliandin peptides activate immune cells (interleukins)

Question 10

Fourth Stage of Autoimmune Response in coeliac disease:

Answer 10

Interleukins activate the adaptive immune system - CD4+ T-cells (gluten specific) cause pro-inflammatory molecules (IFNγ) - TTG antigens (specific to coeliac disease) breaks up gliandin peptides - enhances binding of WBCs with the coeliac halotype - anti-TTG antibodies produced

Question 11

Diagnosis: Histopathology - coeliac disease

Answer 11

Biopsy, differential stain to detect damage caused by coeliac disease (hard to determine villi as inflamed) gaps in staining)

Question 12

Diagnosis: Biochemistry/Immunology - coeliac disease

Answer 12

Serum sample analysed for presence of antibodies specific to coeliac disease e.g. anti-TGA
(98% + in sufferers with gluten diets, 95% - for non-sufferors

Question 13

Prevelance of Coeliac

Answer 13

1/100 - Ireland highest rate
4-9% T1DM have coeliac disease

Question 14

Complications of coeliac disease

Answer 14

~Malnutrition (lack of absorption - inflamed vili - delayed growth, developmental disorders in children),
~bone weakness (lack of Ca & Vitamin D - osteomalacia/Rickets in kids - osteoporosis & osteopenia in adults), infertility & miscarriage (lack of vitamin D),
~ lactose intolerance (intestine problems),
~cancers (intestinal lymphoma),
~seizures,
~neuropathy,
~ spleen disorders

Question 15

Treatment of coeliac disease

Answer 15

Consume gluten free food ( <20 ppm gluten) - dairy, fruits & veg, meat & fish, potatoes, rice, rice noodles, flours (oat, rice, corn, soy, & potato)

Question 16

What is Refractory Coeliac Disease?

Answer 16

Rare (1/140 coeliacs), symptoms continue after exclusion of gluten - medicine (steroids) used to reduce inflammation - caused by inadvertent gluten contamination, microscopic colitis, bacterial overgrowth of small bowel, lactose intolerance, bowel disorders

Question 17

Coeliac disease linked with other diseases

Answer 17

T1DM, Addison’s disease, Thyroid disorders, Liver disorders, Rheumatological disorders, Dermatological disorders ( dermatitis herpetiformis)