Coeliac Disease Flashcards
What is coeliac disease
autoimmune disorder of the small intestine causing prolamin (wheat, barley, rye) intolerance causing villous atrophy and malabsorption. “glucose intolerance”
Who shoulde coeliac be suspected in?
anyone with diarhhoea and weightloss.
OR
anaemia
what is the prevalence of coeliac?
1 in 300-1500
what is the presentation of coeliac?
- stinking stool / diarrhoea
- abdo pain
- bloating
- nausea + vomiting
- apthous ulcer
- angular stomatitis
- weight loss
- fatigue
- weakness
- osteomalacia
- failure to thrive (children)
a third are asymptomatic
What invx would confirm a coeliac diagnosis?
1) Bloods:
- FBC - low Hb
- raised red cell distribution width
- low B12
- low ferritin
2) Antibodies:
- a-gliadin
- transglutaminase
- anti-endomysial
3) Duodenal biopsy at D2 shows villous atrophy, raised WBCs and crypt hyperplasia.
4) gluten free diet makes symptoms reverse
what is the significance of an RCDW (red dell distribution width) test in coeliac?
RCDW (red cell distribution width) is one of the first hints of anaemia.
If the Red cells have different sizes then the width is enlarged.
e. g. iron deficiency anaemia has macrocytic red cells.
e. g. B12/folate deficiency has microcytic red cells.
In coeliac there may be both macro and microcytic red cells as iron and folate malabsorption can occur due to villous atrophy.
So the spectrum of RBC sizes is larger so the RCDW is raised in coeliac disease.
What is the treatment for coeliac?
- lifelong gluten free diet
-
What are the complications of coeliac?
- anaemia
- secondary lactose intolerance
- increased risk of malignancy (gastric, oesophageal, breast, brain, bladder)
- myopathies
- neuropathies
- hyposplenism
- osteoporosis
What malignancies does coeliac increase the risk of?
- gastric
- oesophageal
- bladder
- breast
- brain
