Coeliac Disease and Pernicious Anaemia

Question 1

Give examples of different types of small bowel disease

Answer 1

Coeliac disease
Pernicious anaemia
Crohn’s disease
Infections
Tumours

Question 2

What is coeliac disease

Answer 2

Sensitivity to a-gliaden component of gluten that causes a reactive change inside of the small intestine

Question 3

Give examples of food containing gluten

Answer 3

Wheat
Barley
Spelt
Rye
Kaput
Oats

Question 4

Why do people often think they have coeliac disease when they don’t

Answer 4

Companies list vague symptoms relating to coeliac that are fake and actually apply to their own products trying to trick patients

Question 5

Describe the aetiology of coeliac disease

Answer 5

Immune reaction to a-gliaden
This will create antibodies
T lymphocytes damage mucosal tissue causing villus atrophy

Question 6

Describe villus atrophy

Answer 6

As inflammatory changes take place, the projections into the lumen are lost significantly reducing the surface area of the jejunum available for food absorption

Question 7

What is a common sign of coeliac disease in children

Answer 7

Malabsorption will be obvious as the child will fail to grow properly

Question 8

What is a common dental sign of coeliac disease in adults

Answer 8

Patients appear with oral ulceration

Question 9

What are the symptoms of coeliac disease

Answer 9

Weight loss
Lassitude
Weakness
Abdominal pain/swelling
Diarrhoea
Aphthous ulceration in mouth
Tongue papillary loss
Steatorrhoea
Dysphagia from Plumber Vinson syndrome

Question 10

What malabsorption issues are caused by coeliac disease

Answer 10

Iron
Folic acid
Vitamin B12
Fat

Question 11

What investigations are first carried out for coeliac disease

Answer 11

Antibody tests 
Serum transglutaminase (TTG) - less expensive, delivers a large number of false positives but if negative, patient does not have coeliac
Anti-gliadin/anti-endomyseal antibodies - more expensive and specific

Question 12

What other investigations can be used for coeliac disease

Answer 12

Jejunal biopsy - capsule or endoscopic biopsy
Farcical fat - increased if malabsorption
Haematinics - B12, folate, ferritin

Question 13

What are the advantages of a gluten free diet

Answer 13

Reversal of jejunal atrophy
Improved well-being
Reduced risk of lymphoma

Question 14

What are the disadvantages to a gluten free diet

Answer 14

Social consequences eg - going to a restaurant - menu choices, cross contamination

Question 15

What skin disease is associated with coeliac disease and describe this disease

Answer 15

Dermatitis herpetiformis
Forms little blisters on the skin filled with fluid due to an auto antibody forming against the skin
IgA deposition in the skin tissue

Question 16

How can dermatitis herpetiformis be detected

Answer 16

Immunofluorescence shows antibody binding at the junctional epithelium between the connective tissue and the epithelial surface
The antibody causes there to be a loss of adhesion between the epithelium and connective tissue

Question 17

What is pernicious anaemia

Answer 17

Disease caused by Vitamin B12 deficiency

Question 18

For what reasons can vitamin B12 deficiency occur

Answer 18

Not present adequately in the diet

Seen commonly in vegans

Question 19

How is pernicious anaemia diagnosed

Answer 19

Shilling test (old) - uses radioisotopes to determine whether there is an absorption problem
Now - looking for antibodies against the parietal cells and intrinsic factor

Question 20

What are the different causes of pernicious anaemia

Answer 20

Lack of Vitamin B12 in the diet
Disease of gastric parietal cells
Inflammatory bowel disease of terminal ileum - Crohn’s disease
Bowel cancer at the ileo-caecal junction

Question 21

How can a vitamin B12 deficiency be treated

Answer 21

Have a diet with an adequate quantity of vitamin B12
Take B12 supplements - often contain animal product
Arrange IM injections of B12 every 3 months