Coeliac Disease Flashcards
what is coeliac disease?
an autoimmune disorder characterised by sensitivity to gluten
what is the pathophysiology of coeliac disease?
- gliadin (e.g. a component of gluten) is not fully broken down + crosses the intestinal epithelial layer
- gliadin binds to HLA DQ2 or DQ8, activating T-cells in the intestinal mucosa
- this triggers an immune response, leading to chronic inflammation in the small bowel
- the inflammation damages the epithelium, resulting in malabsorption
what are the risk factors for coeliac disease?
- genetic
- autoimmune thyroid disease
- down’s/william’s syndrome
- T1DM
- IgA-deficiency
what is a mnemonic for remembering which conditions are associated with coeliac disease?
‘I Don’t Take Apples, I Take Oranges’
I - IgA-deficiency
D - down’s syndrome
T - turner’s syndrome
A - autoimmune thyroid disease/autoimmune hepatitis
I - IgA nephropathy
T - T1DM
O - other (e.g. sjögren’s, myasthenia gravis, addison’s)
what are the symptoms of coeliac disease in adulthood?
- intermittent, longstanding diarrhoea
- nausea
- vomiting
- fatigue
- weight loss
- recurrent aphthous stomatitis
- arthralgia
- abdominal pain
- dermatitis herpetiformis
what are the extraintestinal manifestations of coeliac disease?
- arthritis
- dermatitis herpetiformis
- osteoporosis/osteopenia
- infertility
- ataxia
- epilepsy
what are the investigations for coeliac disease?
- anti-tTG antibodies + total IgA count
- IgG EMA, IgG DGP, or IgG tTG if IgA-deficiency
- duodenal biopsy
what does a duodenal biopsy show in coeliac disease?
- villous atrophy
- crypt cell hyperplasia
- intraepithelial cell lymphocytosis
- inflammatory cell infiltration of the lamina propria
what is the management of coeliac disease?
- gluten-free diet
- immunisation (e.g. pneumococcal)
what are the long-term complications of coeliac disease?
- hyposplenism
- iron-deficiency anaemia
- malnutrition
- osteoporosis
- small bowel T-cell lymphoma
- vitamin b12-deficiency/folate-deficiency
