Coeliac disease

Question 1

what is coeliac disease

Answer 1

disorder of the small bowel caused by an immune response to ingested wheat gliadins and related proteins in rye, oats and barley
results in inflammation and tissue damage

Question 2

symptoms of coeliac disease

Answer 2

fatigue, diarrhoea, weight loss, abdominal pain, bloating and indigestion

Question 3

screening of coeliac disease may be reuired for

Answer 3

malabsorption complications eg. iron deficiency anaemia, osteoporosis
micronutrient deficiencies e.g iron, B12, folate
associted conditions eg. dermatitis herpetiformis
primary infertility or recurrent miscarriage
patients with other autoimmune diseases
downs syndrome or turner syndrome
first degree adult relatives with coeliac disease

Question 4

diagnosis of coeliac disease

Answer 4

coeliac serology testing can be done in people consuming 8-10g of gluten per day ie. 4 slices of wheat based bread - cannot be used of people on a gluten free diet
immunoglobulin A anti-tissue transglutaminase and anti-deaminated gliadin antibodies, which are high sensitivie and specific for coeliac disease
total IgA should also be measured to exclude coeliac disease-associated IgA deficiency which can cause false negative tests

Question 5

what diet do people need to be on for coeliac serology to work

Answer 5

coeliac serology testing can be done in people consuming 8-10g of gluten per day ie. 4 slices of wheat based bread - cannot be used of people on a gluten free diet

Question 6

if coeliac testing is positive

Answer 6

arrange endoscopic biopcy of the duodenal mucosa
diagnosis is confirmed by intr epithelial lymphocytosis with blunting of duodenal villi

Question 7

undiagnosed coeliac disease

Answer 7

associated with an increase in GI malignancy and lymphoma
untreated coeliac disease increases the risk of osteoporosis, inron deficiency anaaemia and miscarriage

Question 8

at the time of diagnosis of coeliac disease

Answer 8

investigate newly diagnosed patients for micronutrient deficiencies and screen adults for osteopenia by mesuring bone density
test thyroid function as coeliac disese is associated with autoimmue thyroid disease
do LFTs

Question 9

gluten free diet

Answer 9

only treatment for coelic disease
avoid wheat, rye, oats, brley
may need referral to deititian

Question 10

gold standard to assess response to gluten free diet

Answer 10

normalisation of small bowel villi onn biopsy