Coeliac Disease

Question 1

What is coeliac disease?

Answer 1

An autoimmune disorder characterized by gluten sensitivity, leading to chronic inflammation of the small bowel and malabsorption.

Question 2

What percentage of the UK population is affected by coeliac disease?

Answer 2

Approximately 1%.

Question 3

Which gender is more commonly affected by coeliac disease?

Answer 3

Women, accounting for around two-thirds of cases.

Question 4

At what ages are the peaks for coeliac disease diagnosis?

Answer 4

Infancy (when solid foods are introduced) and between 40-50 years.

Question 5

What component of gluten triggers the immune response in coeliac disease?

Answer 5

Gliadin.

Question 6

Which HLA types are almost all coeliac disease patients positive for?

Answer 6

HLA DQ2 or DQ8.

Question 7

What is the genetic risk of coeliac disease if a monozygotic twin is affected?

Answer 7

Approximately 70%.

Question 8

Name two autoimmune conditions associated with an increased risk of coeliac disease.

Answer 8

Autoimmune thyroid disease and type 1 diabetes.

Question 9

List two genetic syndromes associated with coeliac disease.

Answer 9

Down’s syndrome and Turner’s syndrome.

Question 10

What is the prevalence of coeliac disease in patients with type 1 diabetes?

Answer 10

Approximately 8%.

Question 11

What gastrointestinal symptoms might children with coeliac disease present with?

Answer 11

Chronic diarrhoea, constipation, abdominal bloating, and failure to thrive.

Question 12

What are common symptoms of coeliac disease in adults?

Answer 12

Long-standing diarrhoea, nausea, vomiting, fatigue (often with iron-deficiency anaemia), and weight loss.

Question 13

What skin condition is associated with coeliac disease?

Answer 13

Dermatitis herpetiformis.

Question 14

What are common examination findings in children with coeliac disease?

Answer 14

Failure to thrive, abdominal distension, muscle wasting (particularly of the buttocks), and signs of anaemia.

Question 15

What are common examination findings in adults with coeliac disease?

Answer 15

Signs of anaemia, mouth ulcers, weight loss, abdominal pain, and dermatitis herpetiformis.

Question 16

What are extra-intestinal manifestations of coeliac disease?

Answer 16

Arthritis, osteoporosis/osteopenia, infertility, ataxia, epilepsy, anxiety, and depression.

Question 17

What initial blood tests are recommended for suspected coeliac disease?

Answer 17

Total IgA and IgA tissue transglutaminase (tTG) antibodies.

Question 18

Why is it important to measure total IgA in suspected coeliac disease?

Answer 18

To identify IgA deficiency, which can lead to false-negative tTG antibody results.

Question 19

What is the next step if IgA tTG antibodies are weakly positive or IgA deficient?

Answer 19

Measure IgG-based tests such as IgG deamidated gliadin peptide (DGP) antibodies.

Question 20

What is the definitive diagnostic procedure for coeliac disease?

Answer 20

Duodenal biopsy obtained via upper gastrointestinal endoscopy.

Question 21

What histological findings are characteristic of coeliac disease?

Answer 21

Villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes.

Question 22

What is the mainstay of management for coeliac disease?

Answer 22

A lifelong strict gluten-free diet.

Question 23

Why is adherence to a gluten-free diet crucial in coeliac disease?

Answer 23

To prevent symptoms and reduce the risk of complications such as osteoporosis and small bowel lymphoma.

Question 24

What complications can arise from untreated coeliac disease?

Answer 24

Hyposplenism, iron deficiency anaemia, malnutrition, osteoporosis, small bowel T-cell lymphoma, and vitamin B12 and folate deficiency.

Question 25

What is the role of a dietitian in managing coeliac disease?

Answer 25

To provide education and support for maintaining a gluten-free diet.

Question 26

How often should patients with coeliac disease have follow-up appointments?

Answer 26

Regularly, to monitor adherence to the diet, symptom resolution, and to screen for complications.

Question 27

What vaccinations are recommended for patients with coeliac disease?

Answer 27

Pneumococcal vaccine due to the risk of hyposplenism.

Question 28

Can coeliac disease present asymptomatically?

Answer 28

Yes, some individuals may be asymptomatic but still at risk for complications.

Question 29

What is the significance of dermatitis herpetiformis in coeliac disease?

Answer 29

It is a skin manifestation of coeliac disease, presenting as itchy, blistering skin lesions.

Question 30

Is there a genetic test available for coeliac disease?

Answer 30

HLA DQ2/DQ8 testing can be used to rule out coeliac disease if negative, but a positive result is not diagnostic.

Question 31

What is the importance of family screening in coeliac disease?

Answer 31

First-degree relatives have an increased risk and may benefit from screening.

Question 32

How does coeliac disease affect pregnancy?

Answer 32

It can lead to complications such as infertility, miscarriage, and low birth weight if untreated.

Question 33

What is the relationship between coeliac disease and other autoimmune conditions?

Answer 33

Coeliac disease is associated with an increased prevalence of other autoimmune disorders.

Question 34

Can a gluten-free diet lead to nutritional deficiencies?

Answer 34

Yes, if not well-balanced, it can result in deficiencies of fibre, iron, calcium, and B vitamins.

Question 35

What is refractory coeliac disease?

Answer 35

A rare condition where symptoms persist despite a strict gluten-free diet, requiring further medical evaluation.

Question 36

How does coeliac disease increase the risk of osteoporosis?

Answer 36

Malabsorption of calcium and vitamin D leads to decreased bone mineral density.

Question 37

What is the role of serological testing in monitoring coeliac disease?

Answer 37

To assess adherence to a gluten-free diet and detect inadvertent gluten exposure.

Question 38

Can coeliac disease develop later in life?

Answer 38

Yes, it can be diagnosed at any age, including in the elderly.

Question 39

What is the prevalence of coeliac disease in patients with IgA deficiency?

Answer 39

Approximately 7%.

Question 40

How does coeliac disease lead to iron deficiency anaemia?

Answer 40

Malabsorption of iron in the damaged proximal small intestine.

Question 41

What is the significance of HLA DQ2/DQ8 in coeliac disease?

Answer 41

Presence is necessary but not sufficient for the development of the disease; absence makes the diagnosis unlikely.

Question 42

Can oats be included in a gluten-free diet for coeliac patients?

Answer 42

Pure, uncontaminated oats are tolerated by most, but some may still react; monitoring is advised.

Question 43

What psychological impacts can coeliac disease have?

Answer 43

Anxiety and depression due to chronic illness and dietary restrictions.

Question 44

How does coeliac disease affect children's growth?

Answer 44

Malabsorption can lead to failure to thrive and delayed puberty.

Question 45

What is the role of endoscopy in coeliac disease diagnosis?

Answer 45

To obtain duodenal biopsies for histological confirmation.

Question 46

Can coeliac disease be cured?

Answer 46

There is no cure, but a strict gluten-free diet can effectively manage symptoms and prevent complications.

Question 47

What is the relationship between coeliac disease and lactose intolerance?

Answer 47

Damage to the intestinal lining can lead to secondary lactose intolerance, which may improve with mucosal healing.

Question 48

How does coeliac disease affect dental health?

Answer 48

It can cause dental enamel defects, particularly in children.

Question 49

What is the Marsh classification?

Answer 49

A system used to describe the histological findings in coeliac disease biopsies.