Coeliac Disease

Question 1

Define Coeliac Disease

Answer 1

Systemic autoimmune inflammatory disease that is triggered by dietary gluten peptides found in wheat, rye and related grains

Question 2

Aetiology of Coeliac Disease

Answer 2

T cell response to “gliadin” component of gluten -> mucosal damage -> villous atrophy, crypt hyperplasia, inflammatory infiltration into lamina propria -> GI symptoms + malabsorption

Almost all - DQ2 or DQ8
Associated with autoimmune disease
Mostly in the SECOND part of the duodenum

Question 3

Risk factors of Coeliac Disease

Answer 3

FMHx
IgA deficiency 
T1DM 
Autoimmune-thyroid disease
Down's, Sjogren's, IBD, PBC

Question 4

Epidemiology of Coeliac Disease

Answer 4

Any age, peaks in childhood and 50-60
1:1 sex ratio
Risk is 6x in first degree relatives
20% silent

Question 5

Presenting symptoms of Coeliac Disease

Answer 5

Diarrhoea
Nausea and vomiting
Weight loss 
Steatorrhoea, stinking stools
Abdominal pain and bloating 
Fatigue and weakness
Children: Failure to thrive and growth retardation

Question 6

Signs of Coeliac Disease

Answer 6

Angular stomatitis
Aphthous ulcers
Osteomalacia
Anaemia
Dermatitis herpetiformis (papulovesicular lesions that occur symmetrically over the extensor surfaces)

Question 7

Investigations for Coeliac Disease

Answer 7

IgA-tTG: elevated
IgA: must check as deficiency will give false +ve for tTG
Duodenal biopsy: Intra-epithelial lymphocytes, villous atrophy, crypt hyperplasia

Stool sample: -ve culture, WBC present, faecal calprotectin elevated

FBC: IDA (microcytic, hypo chromic anaemia)
Endomysial antibody (EMA): elevated

Endoscopy and biopsy: villous atrophy, crypt hyperplasia in SI -> flat smooth appearance

Skin biopsy: Granular IgA deposits at the dermal papillae of skin
HLA typing: Positive DQ2 or DQ8

Question 8

Management of chronic Coeliac Disease

Answer 8

Gluten free diet
Vitamin and mineral supplementation e.g, Ergocalciferol 1000-2000 units AND calcium carbonate 1000-1500 units orally

Failure to respond: refer to dietician or specialist

Question 9

Management of a coeliac disease crisis

Answer 9

Rehydration
Correction of electrolyte abnormalities
Corticosteroid e.g. budesonide 9mg orally

Question 10

Complications of Coeliac

Answer 10

Anaemia
Dermatitis herpetiformis
Malabsorption 
Osteopenia/osteoporosis 
Hyposplenism
GI T-cell lymphoma 
Neuropathy

Question 11

Prognosis for Coeliac Disease

Answer 11

Good prognosis
Up to 90% have complete and lasting resolution of symptoms with the gluten-free diet
<1% can expect to develop refractory disease