Coeliac disease

Question 1

What is the epidemiology of coeliac?

Answer 1

Can occur at any age, peaks in infancy and 50s
Slightly more common in women
Genetic components – family links

Question 2

What is the aetiology of coeliac?

Answer 2

Associations

• HLA DQ2 in majority, others are DQ8
• Autoimmune disease

Question 3

What is the pathophysiolgoy of coeliac?

Answer 3

Gluten sensitive enteropathy - T-cell mediated autoimmune disease of the small bowel -

• Prolamin intolerance→ translocate from bowel lumen to mucosa (via faulty tight junctions, endothelial transcytosis, lumen sampling by dendritic cells)→ innate + adaptive immune mechanisms activate → cytokine release + plasma cell Abs form → mucosal damage and villous atrophy → malabsorption
  i) Prolamins = alcohol-soluble proteins in wheat (gliadin), barley, rye +/- oats that are resistant to human proteases

Question 4

How does coeliac present?

Answer 4

Foul smelling diarrhoea, steatorrhoea
Weight loss, anaemia 
Bloating 
Nausea/vomiting 
Abdominal pain 
Fatigue, weakness 
Osteomalacia 
1/3rd are asymptomatic

Question 5

What are some complications of coeliac?

Answer 5

Anaemia 
Secondary lactose intolerance 
↑ risk of malignancy 
Myopathies, neuropathies 
Hyposplenism
Osteoporosis

Question 6

How do you investigate coeliac disease?

Answer 6

Bloods - ↓Hb, B12, ferritin; Abs against – α-gliadin, transglutaminase and anti-endomysial
Endoscopy and biopsy – histology = villous atrophy, crypt hyperplasia,↑ intraepithelial WBCs
Symptoms + test results reverse on gluten free diet

Question 7

How do you treat coeliac disease?

Answer 7

Life-long gluten free diet 
Some staples are available on prescription (standard £8.40) 
i)	Bread/rolls
ii)	Breakfast cereals 
iii)	Crackers 
iv)	Flour 
v)	Oats 
vi)	Pasta 
vii)	Pizza bases 

Lots of good information out there and restaurants often do meals to cater (as its becoming a dietary ‘fad’ as well as a medical condition
Education
i) As some people don’t realise what they can’t eat

Question 8

What rash is associated with coeliac?

Answer 8

Dermatitis hepetiformis (Duhring-Brocq disease)
Blisters appear in clusters resembling herpes simplex but is not viral - IgA mediated immune response to gluten - Abs attack the skin
Symmetrical, scalp/shoulder/buttocks/elbows/knees