Coeliac disease Flashcards
What is coeliac disease?
an autoimmune disease that is characterised by gluten insensitivity.
What percent of the UK is affected by coeliac disease?
around 1 %
Are women or men more likely?
Women
What age range is mostly affected by coeliac disease?
when children are exposed to solid foods
40-50 year old
What is the aetiology of coeliac disease?
In coeliac disease, gliadin, a component of gluten, is not broken down fully and passes through the intestinal epithelial layer triggering an immune response.
Gliadin binds to HLA DQ2 or DQ8 which activates T-cells in the intestinal mucosa leading to the immune response. The immune response results in chronic inflammation within the small bowel, damaging the epithelium and ultimately resulting in malabsorption.5
Almost all patients with coeliac disease are HLA DQ2 positive and many are also DQ8 positive.
what are the risk factors for coeliac disease?
- Genetics (around 70% if monozygotic twin affected)
- Autoimmune thyroid disease
- Genetic syndromes eg Down’s and william’s syndrome
- Type 1 diabetes mellitus
- IgA deficiency
What are the symptoms of coeliac disease in children?
- Failure to thrive (stunted growth, growth chart faltering)
- Chronic diarrhoea
- Constipation (coeliac disease should be considered whenever diagnosing idiopathic constipation)
- Abdominal bloating
- Irritability
- Features of anaemia (adolescents)
Children normally present with these symptoms in the first few years of life as gluten products are introduced to their diets.
What are the typical symptoms of coeliac disease in adults?
- Long-standing diarrhoea (may be intermittent in nature)
- Nausea and vomiting
- Fatigue (patient often have underlying iron-deficiency anaemia)
- Weight loss
What other areas are important areas to cover in the history?
- Family history - coeliac disease often runs in families
- associated conditions
What is the mnemonic for conditions associated with coeliac disease?
Mnemonic: “I Don’t Take Apples, I Take Oranges”
What does the Mnemonic: “I Don’t Take Apples, I Take Oranges” stand for?
IgA deficiency
Down’s syndrome
Turner’s syndrome
Autoimmune thyroid disease and autoimmune hepatitis
IgA nephropathy
Type 1 diabetes mellitus
Other autoimmune conditions (e.g. Sjögren’s, myasthenia gravis, Addison’s disease)
What specific antigen activates the autoimmune reaction in coeliac disease?
gliadin antigen
What are the 3 antibodies produced in coeliac disease:
1) anti-tissue transglutaminase antibodies (anti-TTG)
2) anti-endomysial antibodies (anti-EMA)
3) anti-deaminated gliadin peptide antibodies (anti-DGP)
Which region of the small intestine is mainly affected by coeliac disease?
jejunum
Give 3 features of bowel inflammation seen in coeliac disease:
1) villous atrophy
2) crypt atrophy
3) increased intraepithelial lymphocytes