Coeliac disease

Question 1

What is coeliac disease?

Answer 1

Inflammatory disease caused by intolerance to GLUTEN, causing chronic intestinal malabsorption.
Leads to subtotal villous atrophy + crypt hyperplasia

Question 2

Give 2 epidemiological facts about coeliac disease

Answer 2

1/ 100 in UK

Only 10-20% diagnosed

Question 3

Describe the aetiology of coeliac disease

Answer 3

Due to sensitivity to the GLIADIN component of gluten

Exposure to gliadin triggers immunological reaction in the small intestine leading to mucosal damage + loss of villi

Question 4

List 5 symptoms of coeliac disease

Answer 4

Abdominal discomfort, pain + distention
Steatorrhoea/ Diarrhoea
Tiredness, malaise, weight loss (despite normal diet)
Failure to ‘thrive’ in children
Amenorrhoea in young adults

Question 5

List 3 signs of coeliac on examination

Answer 5

Anaemia: pallor
Malnutrition: Short stature, abdo distension, wasted buttocks, Triceps skinfold thickness indicates fat stores
Vitamin/mineral deficiencies: osteomalacia, easy bruising + dermatitis herpetiformis

Question 6

Name a risk factors for coeliac disease

Answer 6

FH: HLA DQ2

Question 7

What bloods would you request in suspected Coeliac?

Answer 7

FBC (low Hb, iron + folate) 
U+Es 
Albumin  
Calcium 
Phosphate  
LFTs raised

Question 8

What serological antibody findings would be diagnostic of coeliac disease?

Answer 8

Total IgA (identify deficiency)
Antibodies:
IgA tissue transglutaminase = tTg
IgA anti-endomysial = EMA

Question 9

Why test stool in suspected coeliac?

Answer 9

To exclude infection

Test for faecal fat = steatorrhoea

Question 10

What does a D-xylose test show in coeliac disease?

Answer 10

reduced urinary excretion after oral xylose indicates small bowel malabsorption

Question 11

Why perform an endoscopy in coeliac disease? What does this show?

Answer 11

For direct visualisation of villous atrophy in the small intestine
Mucosa appears flat + smooth

Question 12

What will biopsy show in coeliac disease?

Answer 12

Villous atrophy + crypt hyperplasia in the duodenum
Epithelium adopts a cuboidal appearance: there is an inflammatory infiltrate of lymphocytes + plasma cells in the lamina propria

Question 13

What do you need to advise a coeliac patient?

Answer 13

Avoid Gluten

Question 14

What medications may be prescribed in management of coeliac disease?

Answer 14

vitamin + mineral supplements.

Oral corticosteroids if disease does not subside with avoidance of gluten

Question 15

List 6 complications of coeliac disease

Answer 15

Iron, folate + B12 deficiency 
Osteomalacia 
Ulcerative jejunoileitis 
GI lymphoma (particularly T cell)  
Bacterial overgrowth  
Cerebellar ataxia (rarely)

Question 16

Describe the prognosis in coeliac disease

Answer 16

FULL RECOVERY in most patients who strictly adhere to a GF diet
Sx usually resolve within weeks though histological changes may take longer
GF diet must be followed for life