Coeliac disease

Question 1

Define coeliac disease

Answer 1

Systemic autoimmune disease against dietary gluten-> attacks the small intestine

Question 2

Aetiology and risk factors of Coeliac disease

Answer 2

Gluten-> gliadin which resist degradation, Excess transferrin receptors allows gliadin to enter the cell wall-> taken up by macrophage and presented -> anti TTG Ab, Anti-gliadin, anti-endomycial
(these TTG are also found in muscle-but unclear why don’t really get muscle Sx

Leads to breakdown of microvilli (flattened villi), longer crypts (crypt hypertrophy), lymphocyte infiltration-malabsorption

Risk factors
HLA-DR, DQ
Women>men
Fix of coeliac
T1DM

Question 3

Epidiemology of Coeliac

Answer 3

1/100-quite common in UK/US

Question 4

Signs and Symptoms of Coeliac

Answer 4

Dermitis Herpetoformis-large red rash on top of belly (nothing to do with herpes)

Children present-abdominal distention, FAILURE to thrive, Diarrhae

Adults-Chronic diarrhoea, bloating, OTHER VARIED SX
abdo pain
Aneamia-tired

Question 5

Investigation of Coeliac

Answer 5

Initial signs tend to be anaemia

Anti-TTG, anti Gliadin and Anti-endomycial

if thats not enough-> biopsy

Question 6

Management of coeliac

Answer 6

Avoid Gluten
+ vitamin supplements (Vit D and Calcium, possibly iron, B12 and folate

if coeliac crisis-rehydrate and resolve electrolyte imbalance

Question 7

Complications of Coeliac

Answer 7

Commonly-osteoporosis/penia
Dermatitis herpetiformis
IBS, lactose intolerance

increased chance of malignancy in long run
And pancreatitis

Question 8

Prognosis of Coeliac

Answer 8

over 90% won’t have any Sx after removing gluten
10% Sx are mainly with IBS, lactose intolerance or still eat gluten
1% get refractory Coeliac