Coeliac Disease

Question 1

In coeliac disease, what are they sensitive to?

Answer 1

They are sensitive to the protein gluten.

Question 2

What can repeated exposure lead to?

Answer 2

Villous atrophy and malabsorption.

Question 3

What conditions are associated with coeliac disease?

Answer 3

1. Dermatitis herpetiformis (A vesicular, pruritic skin eruption)
2. Autoimmune disorders
   
   • T1DM
   • Autoimmune hepatitis

Question 4

What genetic serotypes are coeliac disease associated with?

Answer 4

1. HLA-DQ2 (95% of patients)
2. HLA-B8 (80%)
3. HLA-DR3
4. HLA_DR7

Question 5

According to the 2009 NICE guidelines, which patients should be screened for coeliac disease?

Answer 5

1. Autoimmune thyroid disease
2. Dermatitis herpetiformis
3. IBS
4. T1DM
5. First degree relatives with coeliac disease.

Question 6

What are some of the signs and symptoms of coleiac disease?

Answer 6

• Chronic or intermittent diarrhoea
• Failure to thrive or faltering growth (in children)
• Persistent or unexplained GI symptoms including nausea or vomiting.
• Prolonged fatigue (tired all the time)
• Recurrent abdominal pain, cramping or distension
• Sudden or unexpected weight loss
• Unexplained iron-deficiency anaemia or other unspecified anemia.

Question 7

What are the steps in diagnosing coeliac disease?

Answer 7

First check IgA tTG.

1. Positive result - refer to gastro.
2. Negative test
   
   • Test IgA Total (NOTE: a false negative for IgA tTG can occur if person IgA deficient.
   • If IgA deficient, test IgG tTG.
     
     • If IgG tTG positive - Refer to gastro
   • If IgG and tTG negative - unlikely Coeliac disease. Consider gluten-free trial. But can refer if high clinical suspicion.

Question 8

What dietary considerations should be considered before serology testing?

Answer 8

1. Testing is accurate only if they eat gluten.
2. They need to eat gluten in multiple meals throughout the day.
3. They should not start a gluten-free diet until after biopsy.

Question 9

What are some complications of coeliac disease?

Answer 9

1. Aienmaa
2. Hplspeosyinm
3. Ostoeriposos/OloastaecmiaLactose intolerance
4. Enteropathy - associated T-Cell lymphoma of the small intestine.
5. Subfertility

Question 10

What cereals contain gluten?

Answer 10

BROWN (Bread)

• Barley: Beer (whisky ok to drink)
• Rye
• Oats ( Some can tolerate)
• Wheat: bread, pasta, pastry
• NOOOOOO!!!!!

Question 11

3 notable gluten free foods

Answer 11

1. Rice
2. Potatoes
3. Corn (maize)

Question 12

What is the prevalence of coeliac disease in a first degree relative of someone with coeliac disease?

Answer 12

1 in 10

Therefore it is important to test relatives regardless of symptoms.