Coeliac Disease

Question 1

What is the main complication of coeliac disease?

Answer 1

Iron deficiency anaemia

Question 2

Describe the clinical presentation of coeliac disease

Answer 2

Steatorrhoea (fatty stools)
Nausea and vomiting
Abdo pain
Bloating
Weight loss
Fatigue
Failure to thrive in children
Osteomalacia
symptoms of malabsorption of essential minerals and vitamins
dermatitis herpetiformis

Question 3

What are the 3 main histological findings in coeliac disease? (you would get these from a duodenal biopsy)

Answer 3

Villus atrophy
Lymphocyte infiltration
Hypertrophy of crypts

Question 4

What tests would you order for suspected coeliac disease?

Answer 4

Blood test for tTG IgA (transglutaminase)
HLA-DQ2/8 gene testing
Endoscopy with duodenal biopsy (Gold standard)

Question 5

How do you treat coeliacs disease?

Answer 5

Gluten free diet for life

Question 6

Explain the path-physiology of coeliac disease

Answer 6

Villus atrophy–>decreased amino acid, Na and H2O absorption–>diarrhoea–>increased pH as HCO3- lost–>intraepithelial lymphocytes–>crypt hyperplasia–>inflammation of lamina propria

Question 7

what is the gold standard investigation for coeliacs disease?

Answer 7

duodenal biopsy

Question 8

is coeliacs disease more common in males or females?

Answer 8

females

Question 9

what HLA variants are common in coeliacs disease?

Answer 9

HLA- DQ2 and DQ8

Question 10

what antibodies would you look at in suspected coeliacs disease?

Answer 10

anti TTG
ant endomyseal
gliadin antigen

Question 11

what would you find on a duodenal biopsy in coeliacs disease?

Answer 11

villous atrophy
crypt hyperplasia
intraepithelial lymphocytosis