Coeliac Disease

Question 1

95% of sufferers have what gene?

Answer 1

HLA DQ2

Question 2

More common in what nationality?

Answer 2

Irish

Question 3

When should you suspect coeliac?

Answer 3

ANY patient with diarrhoea and weight loss/anaemia (esp iron deficiency anaemia)

Question 4

Any particular age group more at risk?

Answer 4

Occurs in all ages peaking in infancy and 50-60 yr olds

Question 5

Prevalence in those with a first degree relative and a sibling respectively are?

Answer 5

10% and 30% of developing coeliacs

Question 6

Presentation, name 5 symptoms or signs…

Answer 6

Steatorrhoea (due to decreased bile salt re absorption), stinking stools, diarrhoea, abdo pain, bloating, N+V, aphthous ulcers, angular somitis, weight loss, fatigue, osteomalacia, failure to thrive (1/3 asymptomatic)

Question 7

What investigations would you do?

Answer 7

Bloods, antibodies and endoscopy

Question 8

What would bloods show?

Answer 8

Decreased Hb, ferritin, B12, increased RCDW (variation in diameter of RBCs)

Question 9

What antibodies would you use?

Answer 9

Alpha gliadin, transglutaminase, anti-mysial antibody 95% specificity

Question 10

What would you see on endoscopy with biopsy

Answer 10

Sub total villus atrophy and increased WBCs between epthelia and crypt hyperplasia which REVERSES on removal of gluten from their diet

Question 11

Exclude coeliac if they have a diagnosis of what?

Answer 11

IBS

Question 12

What is the treatment of coeliacs?

Answer 12

Life long gluten free diet

Question 13

Complications

Answer 13

Lactose intolerance, risk of malignancy, myopathy, neuropathy, hyposplenism, osteoporosis

Question 14

What is coeliac disease?

Answer 14

T cell mediated autoimmune disease causing prolamin intolerance (found in gluten foods) causing villus atrophy and malabsorption