Coeliac Disease And Permicious Anaemia

Question 1

What does coeliac disease cause a sensitivity to?

Answer 1

Alpha - gliaden component of gluten

Question 2

Describe coeliac disease aetiology

Answer 2

1. Genetic susceptibility
   - various subtypes
2. Environmental trigger
3. Consumption of gluten
4. T lymphocytes damage mucosal tissue
5. Villous atrophy

Basically the alpha gliaden component of food with gluten (e.g. wheat) passes through the bowel walk and causes an immune response

Question 3

What does coeliac disease do to the jejunal mucosa?

Answer 3

Subtotal villous atrophy of the jejunum

Question 4

What are the clinical and sub-clinical effects of jejunal atrophy?

Answer 4

1. Clinical (30-40%):
   - growth failure
   - oral ulceration
2. Sub clinical
   - no effects

Question 5

What are classic symptoms of coeliac disease?

Answer 5

1. Weight loss
2. Diarrhoea
3. Steatorrhea
4. Oral aphthous ulceration
5. Tongue papillary loss

Question 6

What are typical malabsorption issues that arise with coeliac disease?

Answer 6

1. Iron
2. Folate
3. Vitamin B12
4. Fat

Question 7

What are investigations used to try and detect coeliac disease?

Answer 7

1. Autoantibody test
   - serum transglutaminase (TTG)
   - anti-gliadin/anti-endomyseal antibodies
2. Jejunal biopsy
   - capsule
   - endoscopic biopsy
3. Faecal fat - increased if malabsorption
4. Haematinics - b12, folate, ferritin

Question 8

What is the outcome of a gluten free diet for coeliac disease?

Answer 8

1. Reversal of jejunal atrophy
2. Improved well-being
3. Reduced risk of lymphoma

Question 9

What skin condition is associated with coeliac disease?

Answer 9

Dermatitis herpetiformis

Question 10

What symptoms are associated with dermatitis herpetiformis?

Answer 10

Oral disease - ulceration and blisters

Granular IgA deposit in skin and mucosa
- itch and blisters - usually over the shoulders but can be widespread

Question 11

How are deficiency’s in coeliac disease patients sometimes detected?

Answer 11

Screening of aphthous ulcer patients

- folate or combined ferritin and folate deficiency suggests malabsorption

Question 12

What causes pernicious anaemia?

Answer 12

Vitamin b12 deficiency

Question 13

What do parietal cells produce ?

Answer 13

Intrinsic factor

Question 14

Why can vitamin b12 absorption often fail to occur

Answer 14

Complex absorption process:

• needs salivary factors, intrinsic factor and functioning of a discrete area of the terminal illeum
• if any one of these fails, vitamin b12 will not be absorbed

Question 15

What is the best way to try and diagnose pernicious anaemia?

Answer 15

Test for intrinsic factor and parietal cell antibodies

Question 16

What can cause vitamin b12 deficiency which leads to pernicious anaemia?

Answer 16

1. Lack of vitamin b12 in diet
   - vegans most at risk
2. Disease of gastric parietal cells
   - auto-immune disease
3. Inflammatory bowel disease of terminal ileum
   - Crohn’s disease
4. Bowel cancer at IKEA-coecal junction
   - resection removes the absorptive tissue

Question 17

How is vitamin b12 deficiency treated?

Answer 17

1. patient responsibility
   - adequate vitamin b12 in diet
   - take vitamin b12 supplements if prescribed
2. Medical responsibility
   - arrange IM injections of vitamin B12 if GI absorption is not possible