Coeliac Disease

Question 1

Which patients should be screened for coeliac disease?

Answer 1

GI symptoms
faltering growth
fatigue
weight loss
mouth ulcers
iron, vitamin B12, folate deficiency
T1DM
autoimmune thyroid disease
first degree relative with coeliac
metabolic bone disorder
subfertility
persistently raised liver enzyme with no other cause
down's syndrome
turner syndrome

Question 2

Which antibodies are used for coeliac serology?

Answer 2

tissue tranglutaminase antibody (tTG-IgA)
deamidated gliadin peptide (DGP-IgG)
endomysial antibody (not tested as difficult test)
anti gliadin antibody (whole protein assay - outdated and inaccurate)

Question 3

What test is ordered for coeliac serology?

Answer 3

either tTG-IgA and total IgA (to assess for IgA deficiency and therefore false negatives)
OR
tTG-IgA and DGP-IgG (less commonly done)

Question 4

What are the histological findings of coeliac disease?

Answer 4

villous atrophy, crypt hyperplasia, raised intra epithelial lymphocytes

Question 5

Is villous atrophy pathognomonic of coelaic disease?

Answer 5

no - also present in giardia, CVID, drugs (olmesartan) etc

Question 6

Which HLA genotype is associated with coeliac disease?

Answer 6

HLA DQ2/8

Question 7

Can you diagnose coeliac disease without a biopsy?

Answer 7

yes, in children, no biopsy diagnosis if tTG-IgA is > 10 times upper limit of normal and second blood sample has positive endomysial antibodies

Question 8

What is the NPV and PPV of coeliac HLA genotyping?

Answer 8

very good NPV, poor PPV

Question 9

What is the global prevalence of coeliac disease?

Answer 9

1-2%

Question 10

Why do patients with coeliac disease have a higher risk for pneumococcal sepsis?

Answer 10

hyposplenism

Question 11

What investigations should be done in patients diagnosed with coeliac disease?

Answer 11

TSH, LFTs, fasting BSL, DEXA, iron studies, B12, folate, vit D, magnesium, zinc

Question 12

How long does it take for antibodies to return to normal after starting a gluten free diet?

Answer 12

12 months

Question 13

How long does it take for mucosal healing after starting a gluten free diet?

Answer 13

18 months - 2 years

Question 14

Is repeat scope recommended after starting a gluten free diet?

Answer 14

yes - to assess for mucosal healing

Question 15

What is refractory coeliac disease?

Answer 15

persistent or recurrent malabsorptive symptoms and signs with villous atrophy despite a gluten free diet for more than 12 months

Question 16

What is type 1 refractory coeliac disease?

Answer 16

normal intra-epitheal lymphocytes - treat with immunosuppression

Question 17

What is type 2 refractory coeliac disease?

Answer 17

monoclonal intra epithelial lymphocytes - treat with chemotherapy