Coeliac disease

Question 1

Define coeliac disease

Answer 1

Immune Disorder, genetically susceptible people, gluten (wheat, barley, rye +oats)

Question 2

Gluten - names

Answer 2

Prolamin -antigenic factor, gliadin, hordein, secalinin, avenin

Question 3

Genetically susceptible people? Aetiology

Answer 3

Interaction between gluten, environment (weaning, infections) and genetics, Altered HLA genes especially HLA-DQA2/B1 ->2 (>90%) and 8 (5%)

Question 4

Pathogenesis

Answer 4

Gluten-> goes through gut (small peptide chain, immune to protease enzymes)-> gets deanimated by tTG -> forms complexes with altered DQ -> presented to T-cell-> immune response and circle begins

Question 5

Pathophysiology

Answer 5

Immuneresponse leads to increased inflammation -> gut permeability increases -> antibodies created against tTG -> tTGA and EmA endomysium -> mucosal distruction/ villous atrophy-> malabsoprtion

Question 6

Refactory? Classic vs non-classic?

Answer 6

Persistent/recurrent symptoms and villous atrophy even though gluten free diet 6-12 months. Classis has intestinal symptoms

Question 7

Symptoms of coeliac disease?

Answer 7

Intestinal symptoms: Stomach pain, cramps, bloating, distention, diarrhoea, weight loss, nausea. Non -intestinal: Skin, eye, joint reactions, chronic fatigue, depression, mouth ulcers. Lactose intolerance

Question 8

Complications?

Answer 8

Anaemia, osteoporosis, vitamin deficiencies, some cancers, infertility other autoimmune disorders

Question 9

Prevalence?

Answer 9

1-2% UK, increased risk with 1st degree relatives

Question 10

Presentation?

Answer 10

Kids vs adults 1:9, peak onset 40-60 yrs

Question 11

Diagnosis

Answer 11

Blood tests and then intestinal biopsy. Check for IgA tTGA/EmA-> test for IgA deficiency-> IgG tTGA/EmA

Question 12

Intestinal biopsy?

Answer 12

Check for villous atrophy and increased amounts of lymphocytes

Question 13

Problem with testing?

Answer 13

Only accurate if consuming gluten. At least for 6 weeks, on one meal

Question 14

Treatment?

Answer 14

Completely gluten free diet: advice, counselling, follow-up. Manage symptoms/complications:deficiencies, lacto-int. Increase calcium due to increased risk of osteoporosis (20-50%)/ fracture. Assess current bone condition and vitamin D

Question 15

Treatment for refactory?

Answer 15

Immunosuppressants, parental nutrition

Question 16

Dermatitis hepetiformis? Other immune disorders?

Answer 16

Type 1 (1%), Sjogren’s Syndrome (secretary glands)   (4.5-15%)               	
Addison’s disease