Coeliac Disease

Question 1

What is coeliac disease?

Answer 1

Inflammation of the mucosa of the upper SI when exposed to gluten

Question 2

Explain what happens when a coeliac eats cereal?

Answer 2

Proteins in gluten-containing cereals are resistant to digestion by pepsin & chymotrpsin, and remain in the intestinal lumen, triggering immune responses

Question 3

What happens after an immune response is triggered in coeliac?

Answer 3

Causes inflammation which leads to villous atrophy and crypt hyperplasia; this then leads to malabsorption of other nutrients

Question 4

Coeliac disease usually presents in adults. True or false?

Answer 4

FALSE

Can present at any age

Question 5

Associated diseases with coeliac?

Answer 5

• Thyroid diseases
• Type 1 diabetes
• Sjogren syndrome
• IBD
• IgA deficiency

Question 6

Signs/symptoms of coeliac?

Answer 6

• Abdo pain
• Wt loss
• Diarrhoea/steatorrhoea
• Angular stomatitis on corners of mouth
• Dermatitis herpetiformis on extensor surface of elbows
• Anaemia/malnutrition

Question 7

Long term problems caused by coeliac disease?

Answer 7

Iron/folate deficiency

Osteoporosis

Question 8

1st line investigation for coeliac?

Answer 8

-Serology 
tTG Antibodies (IgA tissue transglutamase antibodies)
EMA (IgA endomysial antibodies)

Question 9

2nd line investigations for coeliac?

Answer 9

-Biopsy

Taken endoscopically may see scalloping of mucosal folds

Question 10

What other investigations apart from 1st/2nd line could be useful?

Answer 10

• Other blood tests (other folate, iron)
• DEXA scan to check bone density
• HLA typing only done if necessary

Question 11

Management of coeliac?

Answer 11

• GF diet
• Vitamin supplements
• Pneumococcal vaccines for pts with splenic atrophy
• Annual Bloods (serology/FBC)
• Screen for other AI conditions

Question 12

DDs for Coeliac?

Answer 12

• IBS

- IBD

Question 13

How patient could present?

Answer 13

• Abdo pain
• Diarrhoea
• Pale sclera
• Wt loss