Coeliac Disease Flashcards
Define Coeliac Disease?
An inflammatory disease caused by intolerance to GLUTEN, causing chronic intestinal malabsorption
It leads to subtotal villous atrophy and crypt hyperplasia
What is the aetiology of Coeliac Disease?
Due to sensitivity to the GLIADIN component of gluten
Exposure to gliadin triggers and immunological reaction in the small intestine leading to mucosal damage and loss of villi
10% risk of first-degree relatives being affected
Clear genetic susceptibility associated with HLA-B8, HLA-DR3 and HLA-DQW2 haplotypes
What is the epidemiology of Coeliac Disease?
UK: 1/2000
West Ireland: 1/300
Rare in East-Asia
What are the presenting symptoms of Coeliac Disease?
May be asymptomatic
Abdominal discomfort, pain and distention
Steatorrhoea
Diarrhoea
Tiredmess, malaise, weight loss (despite normal diet)
Failure to ‘thrive’ in children
Amenorrhoea in young adults
What is Steatorrhoea?
Pale bulky stool with offensive smell and difficult to flush away
What are the signs of Coeliac Disease on physical examination?
Signs of Anaemia
Signs of malnutrition
Signs of vitamin/mineral deficiencies
Dermatitis Herpetiformis
What are the signs of anaemia you can see in Coeliac Disease?
Pallor
What are the signs of malnutrition you can see in Coeliac Disease?
Short stature
Abdominal distension
Wasted buttocks in children
Triceps skinfold thickness gives indication of fat stores
What are the signs of vitamin/mineral deficiencies you can see in Coeliac Disease?
Osteomalacia
Easy bruising
What is dermatitis Herpetiformis?
Intense, itchy blisters on elbows, knees or buttocks
What bloods would you do for Coeliac Disease?
FBC U&Es Albumin Calcium Phosphate
What do you look for specifically on a FBC for Coeliac Disease?
Low Hb, iron and folate
What serology can you use to investigate Coeliac Disease?
IgG anti-gliadin antibodies, IgA and IgG anti-endomysial transglutaminase antibodies can be diagnostic
What’s important to remember with Ig levels in Coeliac Disease?
IgA deficiency is quite common (1/50 with coeliac) so Ig levels should be measured to avoid false negatives
Why do we do a stool culture for Coeliac Disease?
Exclude infection, faecal fat tests for steatorrhoea
What is the use of the D-xylose Test?
Reduced urinary excretion after oral xylose indicates small bowel malabsorption
Why do we do an endoscopy for Coeliac Disease?
Allows direct visualisation of villous atrophy in the small intestine (mucosa appears flat and smooth)
What can we see on a Biopsy for Coeliac Disease?
Show villous atrophy and crypt hyperplasia in the duodenum
The epithelium adopts a cuboidal apperance - there is an inflammatory infiltrate of lymphocytes and plasma cells in the lamina propria
What advice do you give to someone with Coeliac Disease?
Avoid gluten (wheat, rye, and barley products)
What is the medical management plan for Coeliac Disease?
Vitamin and mineral supplements
Oral corticosteroids if disease doesn’t subside with avoidance of gluten
What are the possible complications of Coeliac Disease?
Iron, folate and B12 deficiency Osteomalacia Ulcerative jejunoiletis GI lymphoma (particularly T cell) Bacterial Overgrowth Cerebellar ataxia (rarely)
What is the prognosis for patients with Coeliac Disease?
Full recovery in most patients who strictly adhere to a gluten-free diet
Symptoms usually resolve within weeks though histological changes may take longer
Gluten-free diet must be followed for life
