Coeliac disease

Question 1

Pathophysiology of coeliac disease?

Answer 1

T-cell mediated autoimmune disease of the small bowel, in which prolamin sensitivity causes villous atrophy and malabsorption

Question 2

HLA associations?

Answer 2

HLA-DQ2 (95%)

HLA-DQ8 (80%)

Question 3

Conditions associated with coeliac disease? (4)

Answer 3

Dermatitis herpetiformis
Type 1 diabetes
Autoimmune hepatitis
Autoimmune thyroid disease

Question 4

Presentation of coeliac disease? (5)

Answer 4

Chronic diarrhoea
Fatigue
Failure to thrive/weight loss
Abdominal pain/bloating/cramping
Steatorrhoea

Question 5

How might coeliac be picked up on routine blood tests?

Answer 5

Unexplained iron deficiency anaemia/ B12 or folate deficiency

Question 6

Diagnosis of coeliac disease? (2)

Answer 6

Tissue transglutaminase antibodies

Jejunal biopsy

Question 7

If patients have already commenced a gluten free diet, how long should they be asked to reintroduce gluten for prior to testing?

Answer 7

6 weeks

Question 8

Management of coeliac disease?

Answer 8

Lifelong gluten free diet

Question 9

Which foods are “safe” to eat? (5)

Answer 9

Rice, maize, soya, potatoes, oats

Question 10

Complications of coeliac disease? (5)

Answer 10

Anaemia
GI T-cell lymphoma
Osteoporosis
Lactose intolerance
Hyposplenism