Coeliac Disease Flashcards
What is Coeliac Disease?
Autoimmune condition caused by sensitivity to gluten
What is the main component of gluten?
Gliadin
What signs and symptoms suggest a screening for Coeliac Disease is needed?
- Chronic or intermitted diarrhoea
- Failure to thrive
- Persistent or unexplained GI symptoms
- Prolonged fatigue
- Recurrent abdominal pain, cramping or distention
- Sudden or unexplained weight loss
- Unexplained iron deficiency anaemia
What conditions suggest a screening for Coeliac Disease is needed?
- Autoimmune thyroid disease
- Dermatitis Herpetiformis
- Irritable Bowel Syndrome
- Type 1 Diabetes
- First degree relatives with coeliac disease
What are the common causes of malabsorption?
- Coeliac Disease
- Crohn’s Disease
- Chronic Pancreatitis
What are the rarer causes of malabsorption?
- Decreased bile
- Pancreatic insufficiency
- Small bowel mucosa
- Bacterial overgrowth
- Infection
- Intestinal hurry
What are the main complications of Coeliac Disease?
- Anaemia
- Malabsorption
- Osteopenia and Osteoperosis
- Dermatitis Herpetiformis (itch chronic blistering of skin on the extensor surfaces)
- Small bowel lymphoma
- Hyposplenism
- Lactose intolerance
- Subfertility
What is the clinical presentation of Coeliac disease?
- Symptoms of malabsorption
- Anaemia
- Failure to thrive in children
- Dermatitis herperiformis
What is the pathophysiology of Coeliac Disease?
- Gluten is normally digested by luminal and brush border enzymes in the small intestine into gliadin
- Gliadin is deaminated in the mucosa by tissue transglutaminases
- Those with HLA-DQ8 or HLA-DQ2 haplotypes have gliadin fitting inside MHC complexes of APCs
- This initiated Th2 mediated response, generating cytotoxic T cells against gliadin
- These T cells cause villous atrophy
- Humoral response also activated, leading to generation of anti-gliadin, anti-endomysial and anti-TIG antibodies
What are the investigations in suspected Coeliac Disease/
=> Endoscopy and Duodenal Biopsy - Gold
- Villous atrophy
- Crypt hyperplasia
- Increased intraepithelial lymphocytes
- Lymphocytes infiltrating lamina propria
=> Serology tests - 1st line
- Tissue transglutaminase (tTG) antibodies (IgA) first line
- Endomyseal antibody (IgA) needed to look for selected IgA deficiency which could give false negative coeliac result
=> HLA-DQ8 and HLA-DQ2 genotyping
If person is on a gluten free diet, for investigating, recommend that patient re-introduces gluten into their diet 6 weeks before investigations
What is the management of Coeliac Disease?
- Gluten free diet
- Pneumococcal vaccine which is boosted every 5 years (due to hyposplenism)
- Influenza vaccine
What 3 components does Coeliac disease cause deficiencies in?
- Iron
- Folate
- B12
