Coeliac Disease

Question 1

Coeliac Disease:

Variants of Coeliac Disease?

Answer 1

• Classical (malabsorption, villous atrophy, positive antibodies)
• Non calssical (non GIT symptoms, villous atrophy, positive antibodies)
• Subclinical (no overt symptoms, positive antibodies, intestinal damage)
• Potential (positve antibodies only)

Question 2

Coeliac Disease:

Pathophysiology?

Answer 2

Autoimmune response to deamidated gliadin peptides resulting proliferation of cytotoxic T cells directed towards the mucosa.

Question 3

Coeliac Disease:

Testing?

Answer 3

Serology = tissue Transglutaminase Ab (tTA), Deamidated Gliadin Peptide (DGP) Ab, Endomysial Ab (EMA)
these are all IgA based so in 2% coeliac disease are falsely negative secondary to IgA deficiency - they will require IgG based testing
CHECK IgA levels at same time

Question 4

Coeliac Disease:

How long does gluten need to be in diet prior to tesing?

Answer 4

2 slices of bread per day for 2 - 8 weeks

Question 5

Coeliac Disease:

What about gene testing?

Answer 5

Can test for HLA DQ2/8 - if negative Coeliac Disease is ruled out.
HLA DQ2/8 is positive in 50% of the population without Coeliac Disease

Question 6

Coeliac Disease:

Management?

Answer 6

• Dietitian led lifelong gluten free diet.

- if not strict adherance increases the risk of other autoimmune conditions and small bowel lymphoma

Question 7

Coeliac Disease:

How to monitor?

Answer 7

• 6 month reduction in antibodies on repeat testing
• resolved nutrient deficiencies
• consider screening first degree relatives

Question 8

Coeliac Disease:

Associated conditions?

Answer 8

Endocrine

• thyroid
• DMT1
• Addisons
• Amenorrhoea

Rheumatological

• polyarthritis
• SLE
• Sarcoidosis
• Sjogrens

Haematological

• thrombocytopaenia purpura
• iron deficiency/B12 deficiency anaemia
• lymphoma

GIT

• lactose intolerance
• pernicious anaemia
• pancreatic insufficiency
• microscopic colitis
• GIT cancers

Bone

• osteopenia/osteoporosis
• rickets/osteomalacia

Hepatic

• hepatitis
• primary biliary cirrhosis
• primary sclerosing cholangitis

CNS

• multiple sclerosis
• neuropathy
• Epilepsy
• Depression

Dermatology

• dermatitis herpetiformis
• alopecia
• dental enamel defects
• mouth ulcers

Reproductivity

• infertility
• recurrent miscarriage

Others

• Downs syndrome
• Turners syndrome
• Pneuomococcal pneumonia