Coeliac Disease

Question 1

What is coeliac disease.

Answer 1

Gluten sensitivity leading to small intestinal enteropathy.

It is an inflammatory disorder in genetically susceptible individuals.

Question 2

Who does coeliac disease affect.

Answer 2

It affects all ages.
The peak is in the 5th decade, but occurs throughout the 3rd and 4th decade as well.
It can occur worldwide, but it is more common in Northern Europe.
In adulthood it affects females twice as often as males.
Commoner in Irish.

Question 3

What are the symptoms of coeliac disease. (8)

Answer 3

Lethargy.
Weakness.
Diarrhoea or Steatorrhoea. 
Abdominal pain. 
Mouth ulcers.
Angular stomatitis. 
Reduced fertility. 
Weight loss.

Question 4

What is the sign of coeliac disease.

Answer 4

Anaemia.

Question 5

What are the complications of coeliac disease. (9)

Answer 5

It can result in malabsorption. 
Anaemia. 
Secondary Lactose Intolerance. 
GI T cell lymphoma (although rare).
Increased risk of malignancy. 
Myopathies.
Neuropathies. 
Hyposplenism.
Osteoporosis.

Question 6

What is the prevalence of coeliac disease in the UK.

Answer 6

1%. However, 50% of these are asymptomatic. (this includes undiagnosed ‘silent’ cases of the disease and cases of ‘latent’ coeliac disease = genetically susceptible people who may later develop clinical coeliac disease)

Question 7

What is the clinical presentation of coeliac disease in infants. (3)

Answer 7

It occurs after weaning onto cereals.
It typically presents with:
Diarrhoea. 
Malabsorption.
Failure to thrive.

Question 8

What are the clinical presentations of coeliac disease in children. (4)

Answer 8

Usually presents with non-specific features, such as:
Delayed growth.
Features of malnutrition are found on examination.
Mild abdominal distension may be present.
Affected children have growth an pubertal delay - leading to short stature in adulthood.

Question 9

How does coeliac disease present in adulthood. (7)

Answer 9

Presentation is highly variable, depending on the severity and extent of small bowel involvement.
Some have florid malabsorption.
Others develop non-specific symptoms, such as:
Tiredness.
Weight Loss.
Folate deficiency or iron deficiency anaemia.
Oral ulceration.
Dyspepsia.
Bloating.

Question 10

What is associated with unrecognised coeliac disease. (2)

Answer 10

Mild under-nutrition.

Osteoporosis.

Question 11

What diseases are associated with coeliac disease. (18)

Answer 11

Insulin dependent diabetes mellitus. 
Thyroid disease. 
Primary Biliary Cirrhosis. 
Sjogren's Syndrome. 
IgA deficiency. 
Pernicious anaemia. 
Sarcoidosis. 
Neurological complications: encephalopathy, cerebellar atrophy, peripheral neuropathy, epilepsy. 
Myasthenia gravis. 
Dermatitis hepetiformis. 
Down's syndrome. 
Enteropathy-associated T cell lymphoma. 
Small bowel carcinoma. 
Squamous carcinoma of the oesophagus. 
Ulcerative jejunitis. 
Pancreatic insufficiency. 
Microscopic colitis. 
Splenic atrophy.

Question 12

Where is gluten present. (4)

Answer 12

Cereals.
Wheat.
Barley.
Rye.