Coeliac Disease

Question 1

pathophysiology?

Answer 1

auto-immune disease where exposure to gluten causes auto-immune reaction that causes inflammation in small bowel, mainly jejunum

Question 2

aetiology?

Answer 2

genetic link:

• HLA-DQ2 gene (90%)
• HLA-DQ8 gene

Auto-antibodies:

• anti-tissue transglutaminase (anti-TTG)
• anti-endomysial

both IgA

• deaminated gliadin peptide antibodies

Question 3

epidemiology?

Answer 3

usually starts in childhood but can start at any age

Question 4

symptoms?

Answer 4

• often asymptomatic
• Diarrhoea
• Bloating
• Abdo pain/discomfort
• Fatigue
• Wt loss

FTT in young children

rarely w neurological symptoms:

• peripheral neuropathy
• epilepsy
• cerebellar ataxia

Question 5

signs?

Answer 5

• anaemia secondary to iron, b12 or folate deficiency
• dermatitis herpetiformis
• mouth ulcers

Question 6

associations?

Answer 6

• T1DM- test any new cases for coeliac
• thyroid disease
• auto-immune hepatitis
• PBC
• PSC

Question 7

Ix?

Answer 7

must be done whilst pt remains on gluten diet

• Bloods- antibodies
  
  • check total IgA levels prior to doing this, because if IgA deficiency they will come back negative for coeliac even if they have it. In case of deficiency, can check for IgG versions of antibodies instead
• endoscopy w biopsy

Question 8

findings on biopsy?

Answer 8

• villous atrophy
• crypt hypertrophy

Question 9

Mx?

Answer 9

life-long gluten free diet

Question 10

complications?

Answer 10

Malabsorption:

• vitamin deficiency
• anaemia
• osteoporosis

Malignancy:

• enteropathy-associated T-cell lymphoma of intestine
• NHL
• small bowel adenocarcinoma