Coeliac disease and IBS

Question 1

Presentation coeliac

Answer 1

Weight loss
Diarrhoea
Steathorrhea
Anaemia/osteomalacia
Failure to thrive (children)
Apthous ulcers
Dermatitis herpetiformis

Question 2

Coeliac diagnosis

Answer 2

Anti tissue transglutaminase IgA, with check on all IgA levels to make sure no overall deficiency
Duodenal biopsy while on gluten diet shows villous atrophy + crypt hyperplasia
Genotyping for HLA DQ2 in 95% and DQ8 in rest

Question 3

Coeliac treatment

Answer 3

Lifelong gluten free diet

Limited oat consumption <50g/day may be tolerated in mild patients

Question 4

Complications coeliac

Answer 4

Anaemia
Dermatitis Herpetiformis
Osteopenia/porosis
Inc malignancy risk

Question 5

What is IBS

Answer 5

Mixed abdo symptoms with no organic cause, likely to be intestinal motility/visceral perception disorders or microbial dysbiosis

Question 6

IBS diagnosis

Answer 6

Recurrent abdo pain with 2 of: relief by defecation/altered stool form/altered bowel frequency
Chronic symptoms (bloating, constipation, diarrhoea, incomplete evacuation) exacerbated by stress, menstruation, gastroenteritis
Eliminate other causes

Question 7

IBS treatment

Answer 7

Control symptoms:
constipation - water, fibre, simple laxatives if needed
diarrhoea - avoid sorbitol, caffeine, alcohol/reduce fibre/loperamide after each stool if severe
colic - anti-spasmodics (hyoscine butylbromide 10mg/8h)
psychological - emphasise positives of no debilitating diagnosis, CBT, amitryptiline 20mg at night