Coeliac Disease

Question 1

Coeliac Disease Definition

Answer 1

Coeliac Disease: Autoimmune condition triggered by gluten (found in wheat, barley, rye, oats), causing small intestine damage.

Question 2

Coeliac Disease Diagnosis

Answer 2

Serological Tests: Detect autoantibodies:
Anti-tissue transglutaminase (tTG-IgA).
Anti-deamidated gliadin peptide (DGP-IgG).

Gold Standard: Small intestine biopsy showing flattened villi, crypt hyperplasia, and lymphocyte infiltration.

Genetic Testing: HLA-DQ2/8 genotyping for assessing genetic risk; useful for false-negative serology.

Question 3

Coeliac Disease Pathogenesis & Intestinal Damage

Answer 3

Trigger: Gliadin (component of gluten) increases intestinal permeability and triggers immune responses.

Immune Cascade:
TH1 cytokine production and T-cell inflammation.
Antibodies produced against gliadin and tTG.

Result: Villous atrophy, crypt hyperplasia, and lymphocyte infiltration.

Question 3

Coeliac Disease Symptoms

Answer 3

Adults: Abdominal pain, bloating, diarrhoea, constipation, nausea, fatigue, weight loss.

Children: Failure to thrive, pot belly, GI disturbances.

Question 4

Gluten Sources & Associated Conditions

Answer 4

Gluten Prolamins:
Wheat: Gliadin (primary trigger).
Rye, oats, barley: Contain other prolamins causing reactions.

Associated Conditions: Bone disorders, neurological symptoms, infertility, liver enzyme abnormalities.

Question 5

Coeliac Disease Treatment & Monitoring

Answer 5

Diet: Strict gluten-free diet (GFD), avoiding hidden sources (e.g., medicines, sauces, cross-contamination).

Monitoring:
Check for deficiencies (Fe, folate, Ca, vit D, Zn).
Regular bone density assessments.
Adherence to GFD.

Question 6

Complications of Non-Compliance with a GFD

Answer 6

Malignancy: Increased risk of non-Hodgkin’s lymphoma.

Bone Disorders: Osteomalacia, osteoporosis.

Malnutrition: Malabsorption → micronutrient deficiencies.

Question 7

Importance of Calcium

Answer 7

Bone Health: Builds and maintains bones and teeth; prevents osteoporosis.

Body Functions: Necessary for muscle function, nerve transmission, blood clotting, and heart rhythm regulation.

Question 8

Calcium RDIs

Answer 8

M+W (19-50): 1000mg/day (UI 2500mg/day).
W (51-70): 1200mg/day (UI 2000mg/day).
M (51-70): 1000mg/day (UI 2000mg/day).
M+W (>71): 1200mg/day (UI 2000mg/day).
Pregnancy/Breastfeeding (>19): 1000mg/day (UI 2500mg/day).

CALCIUM ABSORPTION:
Requires balance with nutrients like vitamin D, magnesium, and vitamin K for optimal bone health.

Question 9

Sources of Calcium

Answer 9

Dairy: Milk, cheese, yogurt.

Fortified Foods: Soy milk, orange juice.

Vegetables: Green leafy veg (collards, spinach, kale, turnip greens).

Other Sources: Fish with bones (e.g., sardines), tofu, white beans, almonds.

Question 10

Coeliac Disease Methods of Diagnosis

Answer 10

Gluten Challenge:
Consume gluten-containing foods (bread, pizza, cakes, etc.).
At least 2-4 slices/day for up to 6 weeks.

Serology (Blood Tests):
IgA TTG: Anti-tissue transglutaminase antibodies (best indicator).
IgG DGP: Deamidated-gliadin peptide antibodies.
IgA EMA: Endomysial antibody.
Total IgA: Rules out IgA deficiency.
HLA-DQ2/DQ8 Testing: Excludes CD but does not diagnose.

Small Bowel Biopsy:
Gold Standard: Requires gluten consumption before testing.
Villi damage confirms CD; severe damage = longer recovery.

Question 11

Conditions Associated with Coeliac Disease

Answer 11

Dermatitis Herpetiformis:
Itchy papules on knees, elbows, and buttocks.
Treatment: Dapsone initially, long-term GFD (medication often stopped with lifelong GFD).

Type 1 Diabetes (T1DM):
Prevalence: 8.4% in children with T1DM.
Symptoms: Malabsorption, unstable BGL, low Fe, short stature, delayed puberty.

Refractory Coeliac Disease (Rare):
Persisting villous atrophy despite >12 months strict GFD.
Type 1: Normal T-cell markers; responds to immunosuppressives.
Type 2: Aberrant IEL population; resistant to steroids.

Question 12

Gluten Sources & Conditions

Answer 12

Gliadin: Primary trigger in wheat.

Prolamins: Found in rye, oats, and barley.

Oats: Not GF in Aus/NZ, often contaminated; avoid unless specifically labelled gluten-free.

Associated Conditions: Bone disorders, neurological symptoms, infertility, liver abnormalities.

Question 13

Coeliac Disease Treatment & Monitoring

Answer 13

Diet:
100% gluten-free diet (GFD).
Avoid hidden sources (medicines, sauces, cross-contamination).

Monitoring:
Check for deficiencies: Fe, folate, Ca, vit D, Zn.
Regular bone density scans.
Adherence to GFD.

Question 14

Nutrients Requiring Attention on a GFD

Answer 14

At Diagnosis: Low levels of Ca, folate, Fe, Zn.

If Long-Term Undiagnosed: B12, vit D, protein, kcal/fat.

Long-Term on GFD: Monitor fibre, Ca, iodine, B vitamins, and Fe.

Question 15

Gluten-Free Labelling Standards (AUS/NZ)

Answer 15

Gluten-Free:
Must not contain oats, malt, or derivatives; no detectable gluten (<3 ppm).

Low-Gluten:
May contain up to 200 ppm gluten (e.g., wheat-starch, malt). Not safe for CD.

International Standards:
Gluten-free = <20 ppm (safe for intake <10 mg gluten/day).
In Aus/NZ, products >3 ppm but <20 ppm can’t be labelled gluten-free but are safe.