Coeliac Disease

Question 1

Which organ does coeliac disease affect?

Answer 1

Small intestine

Question 2

What is gluten?

Answer 2

A protein found in wheat

Question 3

Explain the difference between macro- and microcytic anaemia.

Answer 3

Anaemia = decreases in amount of RBC’s or Hb

Macrocytosis = increases RBC MCV

Macrocyctic anaemia = reduced RBC number with remaining having increased MCV

Microcytic anaemia follows the same rule but for reduced MCV

Question 4

What can a low folate indicate?

Answer 4

May be due to not being absorbed properly, meaning in GI terms celiac or crohns due to where it s absorbed from

Question 5

What is the main serological test for coeliac?

Answer 5

The connective sheath around smooth muscle = endomysium

Anti-endomysial antibodies (EMA) produced in coeliac

Anti-transglutaminase (Anti-tTG)

IgA TTG and EMA therefore serological tests

Question 6

What structural changes occur in coeliac disease?

Answer 6

1) crypt hyperplasia (enlargement)

2) villous atrophy

Question 7

What type of disease is coeliac?

Answer 7

It is an auto-immune disease (T-cell mediated)

Question 8

What is the treatment of coeliac?

Answer 8

Strict gluten free diet

Question 9

Describe the genetics surrounding coeliac including genes associated?

What do these genes code for?

Answer 9

All CD sufferers have:

• HLADQ2 (95%)
• HLADQ8 (5%)

But not all positive for this gene have CD (does not work both ways)

These code for MHC

Question 10

What is the gold standard for coeliac diagnosis?

What other tests/steps can help confirm diagnosis?

Answer 10

OGD with duodenal biopsy looking for structural changes associated with CD

Others = antibody testing, reversal with gluten free diet

Question 11

What is the name of the classification for duodenal biopsies?

Answer 11

Marsh classification

Question 12

What is the most common associated malignancy with coeliac disease?

Answer 12

Enteropathy-associated T-cell lymphoma (EATL)

Question 13

What is affected in coeliac due to the structural changes seen?

Answer 13

Absorption

Question 14

Why do coeliacs become anaemic?

Answer 14

Deficient absorption = reduced iron uptake = anaemia

Question 15

What kind of anaemia is associated with reduced iron intake?

Answer 15

Microcytic

Question 16

What is coeliac incidence?

Are males or females more affected?

Answer 16

1:100

1% of population

Females X2 more likely

Question 17

Does smoking increase coeliac risk?

Answer 17

No

Question 18

What are some key determinants between coeliac and IBD?

Answer 18

Pain (sometimes)

Bleeding

Question 19

Giardia can be a differential for coeliac type symptoms.

What is it?

What are it’s symptoms and how can it be differentiated from other GI pathology?

Answer 19

A water bourne parasite

Symptoms come and go in cycles

Question 20

What serology measurement can rise with infection, therefore is important to check against the CRP?

Answer 20

Ferratin

Question 21

A deficiency of what can cause macrocytic anaemia?

Answer 21

Folate and B12

Question 22

Why does coeliac disease cause iron deficient anaemia (microcytic) and not B12 deficient anaemia (macrocytic)?

Answer 22

Coeliac affects the proximal small bowel = iron absorption here

B12 = distal small bowel (ileum) = not affected by coeliac

Question 23

What region of the small bowel is biopsies in suspected coeliac?

Answer 23

Duodenum = D2