Coeliac Disease

Question 1

What is Coeliac’s?

Answer 1

Immune mediated inflammatory condition provoked by gluten

Question 2

What is the clinical presentation of coeliac’s? Give 3 signs and symptoms

Answer 2

Persistent GI symptoms, faltering growth, prolonged fatigue, unexplained weight loss, severe mouth ulcers, Iron, B12 pernicious anaemia

Question 3

What is the pathophysiology of Coeliac’s?

Answer 3

Alpha gladin is the toxic part of gluten
It is resistant to proteases in the GI tract
It passes through the epithelial barrier of the GI tract
Deamination of tissue transglutaminase (ncreasing immunogenicity)
Interacts with antigen presenting cells in the lamina propria via HLA DQ2 and DQ8
This activates gluten sensitive T cells
Inflammatory cascade and release of mediators
Cell damage
Villous atrophy and crypt hyperplasia

Question 4

What is the aetiology of coeliac’s?

Answer 4

Strong association with HLA DQ2 and DQ8

Gluten in the diet

Question 5

What is the diagnostic test for coeliac’s?

Answer 5

Serology - IgA tissue transglutaminase antibodies have a high sensitivity and specificity for coeliacs, endomysial antibodies
Distal duodenal biopsy shows histological changes

Question 6

What is the treatment for coeliac’s?

Answer 6

Gluten free diet, nutritional supplements

Question 7

What are the complications of coeliac;s?

Answer 7

Increased incidence of malignancy and reduced by gluten free