Coeliac Disease

Question 1

Outline the pathophysiology of coeliac disease

Answer 1

Gluten exposure = auto-Abs against tissue transglutaminase (tTG), SI villi inflam/damage/atrophy, malabsorption (vit, min, nutrients), anaemia

Wheat, rye, barley, oats

Considered T cell-mediated

Question 2

What conditions are related to coeliac disease?

Answer 2

T1DM

Down syndrome

Turner syndrome

Autoimmune diseases = thyroid, RA, addisons

Question 3

How does coeliac disease present?

Answer 3

1) Classical form = most common at 9-24m, failure to thrive/ weight loss, loose stool, steatorrhea, anorexia, abdo pain, abdo distention, muscle waste, miserable/behavioural changes
- Histology: crypt hyperplasia and villous atrophy

2) Atypical form: no GI Sx, associated extra GI conditions (osteoporosis, peripheral neuropathy, anaemia, infertility)
- +ve coeliac serology
- limited abnormalities of the SI mucosa

3) Latent form:
- HLADQ2 and/or HLADQ8
- normal intestinal mucosa
- possible +ve serology

4) Silent form: no clinical Sx
- damaged SI mucosa
- +ve serology

5) Potential: may not be Sx
- normal mucosal morphology
- +ve autoimmune serology

Extra-GI Sx = dermatitis herpetiformis, dental enamel hypoplasia, osteoporosis, delayed puberty, short stature, iron-def anaemia, arthritis

Question 4

How should suspected coeliac disease be Ix?

Answer 4

***Must of had gluten in the diet for 6w before testing

Serology = IgA, IgA tissue transglutaminase (tTG)
- if weakly +ve then use IgA endomysial Ab (EMA)

If anti-tTG 10x upper limit of normal, no requirement for endoscopy

Duodenal biopsy if +ve serology (Marsh classification)

(if anti-tTG +ve then all 1st degree relative should be screened)

Question 5

Outline the Mx of coeliac disease

Answer 5

Lifelong gluten free diet

Diet supplements

Annual follow up - Sx, diet compliance, devel, growth, long-term comp

Question 6

List the possible complications of coeliac disease

Answer 6

Anaemia

Osteoporosis/osteopenia

Malignancy

Fertility problems

Depression/anxiety