Coeliac Disease

Question 1

In what foodstuffs is gluten present?

Answer 1

Wheat
Barley
Rye

Question 2

What is gluten broken down into which T cells react to in coeliac disease?

Answer 2

Alpha gliadin

Question 3

Females and more susceptible than males to develop coeliac disease. T/F?

Answer 3

True

Question 4

How many people with coeliac disease carry the HLA-DR2?

Answer 4

95%

Question 5

Other than HLA-DR2 what is the other gene which makes a person susceptible to coeliac disease?

Answer 5

HLA-DR8

Question 6

All people with the HLA-DR2 gene will develop coeliac disease. T/F?

Answer 6

False

Question 7

There is a theory that infection in genetically susceptible individuals can cause coeliac disease. Infection with which virus is thought to do this?

Answer 7

Adenovirus 12

Question 8

How does coeliac disease present in infants?

Answer 8

Presents around 4-24months
Impaired growth
Diarrhoea
Vomiting
Abdominal distension

Question 9

How does coeliac disease present in older children?

Answer 9

Anaemia
Short stature
Pubertal delay
Recurrent abdominal pain
Behavioural disturbance

Question 10

How does coeliac disease present in adults?

Answer 10

IBS like symptoms
Dirahhoea
Flatulence
Abdominal discomfort
Iron deficient anaemia
Reduced fertility or amenorrhoea
Oestoporosis
Unexplained increase in ALT/AST

Question 11

Describe the physiology of coeliac disease?

Answer 11

Alpha gliadin is digested and absorbed intact into the lamina propria through tight junctions which are often leaky in coeliac disease. Exposure to tissue transglutaminase (ttg) will deaminate alpha gliadin and this deaminated gliadin will be processeed by macrophages which oresenf the protein to CD4+ T cells via MHC II molecules coded for by HLA-DR2/8. This causes an inflammatory reaction mediated by t cells whoch damages enterocytes and activated B cells to produce anti ttg and anti EMA antibodies

Question 12

What effect does coeliac disease have on a histological level?

Answer 12

Villi becomes short and flattened
Hypertrophy and elongation of crypts
Increase in plasma and intraepithelial lymphocytes

Question 13

Coeliac disease can cause steatorrhea, fat malabsorption, vitamin deficiency, abdominal pain and vomiting. T/F?

Answer 13

True

Question 14

Vitamin malabsorption (of K and D) can result from coeliac disease. What cknsequences can this have?

Answer 14

Vit d - oestoporosis

Vit k -coagulopathy

Question 15

Why does vitamin b12 malabsorption rarely occur with coeliac disease?

Answer 15

Because coeliac disease mainly effects the duodenum and vit b12 is mostly absorbed in The terminal ileum

Question 16

How is coeliac disease diagnosed?

Answer 16

Serology tests for IgA tTG antibkdy and IgA EMA antibody (although in IgA deficient people this will be an IgG antibody)
Endoscope with biopsy when patient is on gluten rich diet

Question 17

Why are several biopsies taken when investigating potential coeliac disease?

Answer 17

Because coeliac disease causes a patchy pathology

Question 18

Which classification system can be used when looking at coeliac disease biopsy?

Answer 18

Marsh classification

Question 19

What diseases are associated with coeliac disease?

Answer 19

Dermatitis herpetiformis
Type I diabetes mellitus
Thyrotoxicosis
Addisons disease

Question 20

What are the differential diagnoses of coeliac disease?

Answer 20

Giardiasis
CVIDQ
Chrons
Lymphoma
Whipples disease
Tropical sprue
Chronic ischaemia
NSAID use

Question 21

How is coeliac disease treated?

Answer 21

Gluten free diet should see symptomatic improvement in two weeks
Vaccination for certain infections that coeliacs are more susceptible to
Vitamin d supplementation to avoid osteoporosis

Question 22

What is refractory coeliac disease?

Answer 22

Recurrent malabsorptive symptoms and villous atrophy despite strict adherence to GF diet for at least 6-12 months in the absence kf other causes of non responsive treated coelkac disease and overt malignancy

Question 23

How can type I refractory coeliac disease be mananged?

Answer 23

Immunosuppressants such as steroids kr azathioprine

Question 24

Why does type II refractory coeliac disease have a low survival level?

Answer 24

Because it usually progresses to enteropathy associated t cell lymphoma

Question 25

What are the symptoms of enteropathy associated t cell lymphoma?

Answer 25

Weight loss
Night sweats
Itch
Overt or occult GI bleeding
Venous thromboembolism

Question 26

What percentage of enteropathy associated t cell lymphomas are caused by coeliac disease?

Answer 26

13%