Coeliac disease

Question 1

when should you suspect coeliac

Answer 1

diarrhoea + weight loss or anaemia

Question 2

what is it

Answer 2

T cell mediated autoimmune diseaseof small bowel- prolamin intolerance (wheat, barley, rye, oats) causes villous atrophy and malabsorption

Question 3

associations

Answer 3

HLA DQ2 in 95% the rest DQ8, auto immune disease, dermatitis herpetiformis

Question 4

typical age

Answer 4

infancy, and 50-60 years

Question 5

presentation

Answer 5

stinking stools/steatorrhea, diarrhoea, abdo pain, bloating, N&V, aphthous ulcers, angular stomatitis, decr weight, fatigue, weak, osteomalacia, failure to thrive. 1/3 asymptomatic

Question 6

diagnosis

Answer 6

Hb decr, RCDW incr, B12 decr, ferritin decr.

Question 7

what antibodies are used in diagnosis

Answer 7

alpha- gliadin, transglutaminase, anti-endomysial

Question 8

what other tests can be done

Answer 8

duodenal biopsy at endoscopy, subtotal villous atrophy

Question 9

treatment

Answer 9

lifelong gluten free diet, rice maize soya potatoes oats and sugar ok.

Question 10

complications

Answer 10

anaemia, 2ary lactose intolerance, GI T cell lymphoma, incr risk of malignancy, myopathies, neuropathies, hyposplenism, osteoporosis