Coeliac Disease

Question 1

What is Coeliac disease?

Answer 1

It is a T-cell- response to gluten (alcohol-soluble proteins in wheat, barley, rye ± oats) in the small bowel which causes villous atrophy and malabsorption.

Question 2

How do patients present?

Answer 2

Stinking stools/steatorrhoea; diarrhoea;
abdominal pain; bloating; nausea + vomiting; aphthous ulcers;
angular stomatitis
weight loss;
fatigue;
weakness;
osteomalacia; failure to thrive (children).
~30% less severe: may mimic IBS

Question 3

How do you diagnose coeliac disease? (3)

Answer 3

Blood: reduced Hb, increased RCDW, reducud B12, reduced ferritin

Antibodies - IgA anti-transglutaminase, endomyseal antibody (IgA)

Jejunal biopsy while on gluten diet - subtotal villous atrophy, increased intra-epithelial WBCS + crypt hyperplasia

Question 4

How is it treated?

Answer 4

Life-long gluten free diet

Question 5

What are the complications of Coeliac?

Answer 5

Anaemia, dermatitis herpetiformis, ostopenia/osteoporosis, hyposplenism, GI T-cell lymphoma

Question 6

You are reviewing a 45-year-old woman who has a history of coeliac disease in the gastroenterology clinic. Your consultant asks you to check that she is up-to-date with her immunisations. She is otherwise fit and well and her coeliac disease is well controlled. Why do patients with coeliac disease require regular immunisations?

Answer 6

functional hyposplenism.