Coeliac Disease

Question 1

Discuss the prevelance of coeliac disease

Answer 1

• 1 in 100 (30% don’t know they have it)
• Women > men
• Bimodal: infancy, 40/50’s

Question 2

State some risk factors for coeliac disease

Answer 2

• Family history (if first degree relative has it then 1/10 chance)
• Autoimmune thyroid disease
• T1DM
• Immunoglobulin A deficiency

Question 3

What is coeliac disease?

Answer 3

Autoimmune response to gliadin fraction of glute

Question 4

What are the symptoms of coeliac disease?

Answer 4

• Diarrhoea
• Steatorrhoea
• Bloating
• Flatulence
• Nausea & vomitting
• Weight loss
• Abdo pain
• Fatigue
• Dermatitis herpetiformis

Or asymptomatic anf found when investigating e.g. Fe deficiency anaemiaor due to family history

Question 5

Explain why you get each of the following in coeliac:

• Weight loss
• Diarrhoea
• Flatulence

Answer 5

• Weight loss: destruction of villi leading to decreased SA for absorption- malabsorption
• Diarrhoea: malabsorption leads to increased osmolarity of lumen hence less water leaves lumen
• Flatulence: bacteria in gut ferment unabsorbed substances in bowel and produce gas

Question 6

What might you find on clinical examination of someone with coeliac disease?

Answer 6

• Abdo pain
• Visible bloating
• Aphthous mouth uclers
• Angular stomatitis
• Dermatitis herpetiforms

Question 7

What is dermatits herpetiforms?

Answer 7

Characterised by intensely pruritic papulovesicular lesions that occur symmetrically over the extensor surfaces of the arms and legs, as well as on the buttocks, trunk, neck, and scalp

Question 8

What investigations would you do if you suspect coeliac disease, include:

• Bedside
• Bloods
• Imaging

Answer 8

Bedside

• Stool culture & microscopy: rule out infection

Bloods

• FBCs: aneamia
• Ferriting, TIBC, transferrin saturation: Fe deficiency
• B12: deficiency
• Folate: deficiency
• Antibody screen (anti-tissue transglutaminase antibody (specific IgA), IgA levels): positive

Imaging

• OGD and duodenal biopsy: look for features of coeliac

Question 9

What is the gold standard diagnostic test for coeliac disease?

Answer 9

OGD & duodenal biopsy

*NOTE: tTG is rasied in most cases of coeliac disease but IS NOT DIAGNOSTIC test in adults

Question 10

What would see on OGD and biopsy of someone with coeliac disease?

Answer 10

• Subtotal villous atrophy
• Intra-epithelial lymphocytes
• Crypt hyperplasia

Question 11

Discuss the management of coeliac disease

Answer 11

• Gluten free diet

Question 12

What foods is gluten found in?

Answer 12

Wheat, rye, barley and oats

Question 13

State some potential complications of coeliac disease

Answer 13

• Anaemia
• Osteoporosis
• Hyposplenism
• Increased risk of malignancy (MALToma [T-cell lymphoma])

Question 14

Why do we offer pts with coeliac disease pneumococcal vaccination?

Answer 14

Can have hyposplenism (immunsupressed)