Coeliac disease

Question 1

What is coeliac disease

Answer 1

Autoimmune disorder
Abnormal reaction to gluten
Results in malnutrition

Question 2

Which part of the GI tract is affected?

Answer 2

Small intestine

Question 3

Genetics

Answer 3

HLADQ2 / HLADQ8 are needed in order to develop coeliac disease

Question 4

Causative antigen

Answer 4

Gluten

- Gliadin peptide (component of gluten)

Question 5

Immunopathogenesis

Answer 5

Gliadin peptide (antigen) presents to T cells and causes T cell activation
- subsequent activation of plasma cells and lymphocytes
- production of pro-inflammatory cytokines
This damages the intestinal epithelium
Epithelial cells are killed
Every time gluten is encountered, the epithelial cells are destroyed
If you stop eating gluten then symptoms are relieved

Question 6

Histology

Answer 6

Villous atrophy
Villi are flat - less absorptive capacity
Scalloping

Question 7

Investigations

Answer 7

Endoscopy
- Duodenal biopsy (2nd part)
Serology
- IgA anti-tissue transglutiminase auto antibodies (TTG)

Question 8

Duodeal biopsy indications

Answer 8

Patient must continue eating gluten until biopsy is performed
Biopsy 4 times

Question 9

TTG indications

Answer 9

IgA levels must be normal for this test to work

- if IgA deficient then it won’t work

Question 10

Clinical presentation

Answer 10

Diarrhoea
Abdominal pain/discomfort 
Weight loss
Anaemia 
Abdominal bloating 
Flatulence 
Recurrent oral ulcers
Nausea
Tiredness
Can be asymptomatic

Question 11

Management

Answer 11

Gluten free diet