Coeliac Disease Flashcards
What is Coeliac disease
Abnormal lining of SI
Previous Diagnosis of Coeliac disease
Severe weight loss Multiple nutrient absorption problems 1. Small Intestine Biopsy 2. Gastroscopy- Duodenal Biopsy \+ Blood tests: a) Previously: glaidin antibodies (high false +ve and -ve tests) b) Now: Tissue Transglutaminase Ab, TTG - more accurate antibody tests
Coeliac Iceburg Analogy
Overt severe disease on top
- Majority= Mild or silent disease = below sea level
- Symptomatic –> Silent –> Latent
- symptomatic + silent = Mucosal lesion
- latent= normal mucosa
- All Genetic susceptibility Positive serology: DQ8 and DQ2
- alot more people now w. mild coeliac disease
Coeliac Genetic component
1:10 incidence if 1st degree relative
-2x susceptibility genes: DQ 8 and 2
Common in Northern Europe
w/o DQ2= cannot develop coeliac = Jap and Chinese
Pathogenesis, Pathology and Pathophysiology of Coeliac disease
Pathogenesis: Gluten exposure-abnormal cell and hormone response = causes mucosal damage
Pathology: villus atrophy. crypt hypertrophy. intraepithelial lymphocytes.
Pathophysiology =1. loss of brush border enzymes. 2. Loss of stimulus for pancreatic and bile secretion
Antibodies against enzyme tranglutaminases
Not cytotoxic
Enzyme Transglutaminases AB are a by-product of inflammation and damage
Childhood Coeliac
- Failure to thrive
- Diarrohea, irritable, poor appetite
- May: Iron deficiency
- May: Short and Abdominal distention
part of Family screening
Adult Coeliac
(presumably silent in childhood)
- Abdominal bloating and discomfort
- 50% coeliacs abdominal symptoms - Iron deficiency (w. or w/o anaemia)
- Folate deficiency = high likelihood is coeliac
- Relative screening
- 1:10 first degree rel. 1:35 second degree rel.
- 25% coeliacs identified due to relative screening
Request for Coeliac antibodies
Unexpected Iron deficiency Folate/B12 deficiency Fatigue IBS w. prominant bloating Osteoporosis (early onset/severe) Type 1 Diabetes (insulin 4% +ve) Autoimmune Thyroid disease (5%)
Official Coeliac diagnosis
- Blood test initially
- Test family for HLA DQ 8 and 2
- Antibody test
- if +ve 4. Confirm via Gastroscopy and Duodenal biopsy
Is Gluten free diet sufficient evidence for Coeliac Disease
No Other conditions (such as IBS) can also benefit from/decrease symptoms due to removal of bread
Coeliac Disease Treatment
gluten free diet = ONLY treatment
- Rapid improvement of symptoms
- symptoms may continue to improve for 6-12 months
- Adherence is easier if clear correlation b/w gluten exposure & Abdominal symptoms. (some people do not have clear relationship so inadvertently consume gluten without worry)
- Gluten free is now more commercially available
- Dietary supplements not usually required, except in first 6-12 months if have severe nutrient deficiencies (can promptly replace vit D if required)
Coeliac Intolerance to protein fractions
Wheat: glaidin
Rye: secalins
Barley: hordein
-known due to plant taxonomy
-these grains are really similar- due to a/acid sequence which is involved in initiating the immune process
-corn and rice harmless. oats debatable (but are a good source of fibre)
-quinoa/buckwheat, amaranth, millet (safe accor. to plant taxonomy) + now more widely available
-meat/fish/vege/fruit natural sources okay (apart from cereals)
Processed items ? due to contamination
Wheat starch (in processed food) Distilled Alcohol (from wheat, barley, rye) Distilled White Vinegar Malt + Malt extract -if in doubt leave out
Fibre and Gluten free diet
Sufficient fibre can be problem in gluten free diet
-Constipation pot. problem
High fibre cereal alternatives recommended
+ Good fruit/vege intake
