Coeliac Disease

Question 1

What is Coeliac disease?

Answer 1

Enteropathy induced by gluten (in wheat barley and rye)
Damage small intestinal mucosa
Villous atrophy
This leads to malabsoption

Question 2

How does Coeliac’s present?

Answer 2

Malabsorptive syndrome at 8-24 months of age after the introduction of wheat containing weaning foods

Faltering growth
Abdominal distention
Buttok wasting
Abnormal stool
Irritability

Non specific GI symptoms
Anaemia
Growth faltering

Question 3

How is Coeliac’s diagnosed?

Answer 3

Serology:
Raised IgA anti-tissue transgluaeminase IgA-anti-tTG and endomysial antibodies (EMA)

Duodenal biopsy shows lymphocytic infiltration and villous atrophy

Question 4

How is Coeliac’s disease managed?

Answer 4

Villi return to normal on special diet
Gluten free diet - no wheat, barley, rye (no bread, cake, pasta pizza, pies)

Rice, maize, soya, potato are OK
<25g/day of pure oats

Supervision by dietician

Question 5

What are other causes of malabsorption?

Answer 5

Cholestatic liver disease of biliary atresia
- Bile salts cannot enter the duodenum - fat malabsorption

Exocrine pancreatic dysfunction
Cystic Fibrosis
- Abset lipase, protease, and amylase leads to defective digestion

Small intestinal mucosal disease:
Loss of absorptive surface area - Coeliac’s

Short bowel sydnrome
- small intestinal resection due to congenital anomalies or necrotising enterocolitis

Loss of terminal ill function
- Reduced bile acid and B12 absorption