Coeliac disease in adults Flashcards
What is coeliac disease?
Coeliac disease is an autoimmune condition caused by sensitivity to the protein gluten.
What percentage of the UK population is thought to be affected by coeliac disease?
It is thought to affect around 1% of the UK population.
What leads to malabsorption in coeliac disease?
Repeated exposure to gluten leads to villous atrophy, which in turn causes malabsorption.
What skin condition is associated with coeliac disease?
Dermatitis herpetiformis, a vesicular, pruritic skin eruption.
What autoimmune disorders are associated with coeliac disease?
Type 1 diabetes mellitus and autoimmune hepatitis.
What HLA types are strongly associated with coeliac disease?
HLA-DQ2 (95% of patients) and HLA-DQ8 (80%).
What did NICE issue in 2009 regarding coeliac disease?
NICE issued guidelines on the investigation of coeliac disease.
What are some signs and symptoms that should prompt screening for coeliac disease?
Chronic or intermittent diarrhoea, failure to thrive or faltering growth (in children), persistent gastrointestinal symptoms, prolonged fatigue, recurrent abdominal pain, sudden weight loss, unexplained anaemia, autoimmune thyroid disease, dermatitis herpetiformis, irritable bowel syndrome, type 1 diabetes, and first-degree relatives with coeliac disease.
What are some complications of coeliac disease?
Anaemia (iron, folate, and vitamin B12 deficiency), hyposplenism, osteoporosis, lactose intolerance, enteropathy-associated T-cell lymphoma, subfertility, and unfavourable pregnancy outcomes.
What rare malignancies are associated with coeliac disease?
Oesophageal cancer and other malignancies.
What causes coeliac disease in children?
Coeliac disease is caused by sensitivity to the protein gluten.
What leads to villous atrophy in coeliac disease?
Repeated exposure to gluten leads to villous atrophy, which causes malabsorption.
At what age do children typically present with coeliac disease?
Children normally present before the age of 3 years, following the introduction of cereals into the diet.
What is the incidence of coeliac disease?
The incidence of coeliac disease is around 1:100.
Which HLA types are strongly associated with coeliac disease?
Coeliac disease is strongly associated with HLA-DQ2 (95% of patients) and HLA-DQ8 (80%).
What features may coincide with the introduction of cereals in coeliac disease?
Features may include failure to thrive, diarrhoea, and abdominal distension.
How may older children present with coeliac disease?
Older children may present with anaemia.
When are many cases of coeliac disease diagnosed?
Many cases are not diagnosed until adulthood.
What is a key diagnostic test for coeliac disease?
A jejunal biopsy showing subtotal villous atrophy is a key diagnostic test.
What are useful screening tests for coeliac disease?
Anti-endomysial and anti-gliadin antibodies are useful screening tests.
What causes coeliac disease?
Coeliac disease is caused by sensitivity to the protein gluten.
What are the consequences of repeated exposure to gluten in coeliac disease?
Repeated exposure leads to villous atrophy which in turn causes malabsorption.
What conditions are associated with coeliac disease?
Conditions associated with coeliac disease include dermatitis herpetiformis and autoimmune disorders such as type 1 diabetes mellitus and autoimmune hepatitis.
How is coeliac disease diagnosed?
Diagnosis is made by a combination of serology and endoscopic intestinal biopsy.
What happens to villous atrophy and immunology on a gluten-free diet?
Villous atrophy and immunology normally reverses on a gluten-free diet.
What guidelines did NICE issue regarding the investigation of coeliac disease?
NICE issued guidelines on the investigation of coeliac disease in 2009.
What should patients do if they are already on a gluten-free diet before testing?
Patients should be asked, if possible, to reintroduce gluten for at least 6 weeks prior to testing.
What is the first-choice serology test for coeliac disease according to NICE?
Tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE.
What is the purpose of endomyseal antibody testing?
Endomyseal antibody (IgA) is needed to look for selective IgA deficiency, which would give a false negative coeliac result.
Are anti-gliadin antibody tests recommended by NICE?
Anti-gliadin antibody (IgA or IgG) tests are not recommended by NICE.
What is the ‘gold standard’ for diagnosing coeliac disease?
Endoscopic intestinal biopsy is the ‘gold standard’ for diagnosis.
Where is the endoscopic intestinal biopsy traditionally performed?
Traditionally done in the duodenum but jejunal biopsies are also sometimes performed.
What findings are supportive of coeliac disease?
Findings supportive of coeliac disease include villous atrophy, crypt hyperplasia, increase in intraepithelial lymphocytes, and lamina propria infiltration with lymphocytes.
Is rectal gluten challenge widely used?
Rectal gluten challenge has been described but is not widely used.
What is the primary management for coeliac disease?
The management of coeliac disease involves a gluten-free diet.
Which cereals contain gluten?
Gluten-containing cereals include wheat, barley, rye, and oats.
What are examples of gluten-containing foods made from wheat?
Examples include bread, pasta, and pastry.
Is whisky safe for patients with coeliac disease?
Whisky is made using malted barley, but proteins such as gluten are removed during the distillation process, making it safe to drink for patients with coeliac disease.
What notable foods are gluten-free?
Gluten-free foods include rice, potatoes, and corn (maize).
How can compliance with a gluten-free diet be checked?
Tissue transglutaminase antibodies may be checked to assess compliance.
What vaccination is recommended for patients with coeliac disease?
All patients with coeliac disease are offered the pneumococcal vaccine.
How often should patients with coeliac disease receive the pneumococcal vaccine booster?
Patients should have a booster every 5 years.
What does Coeliac UK recommend regarding pneumococcal vaccination?
Coeliac UK recommends that everyone with coeliac disease is vaccinated against pneumococcal infection.
How is the influenza vaccine administered to patients with coeliac disease?
Current guidelines suggest giving the influenza vaccine on an individual basis.
Duodenal biopsy from a patient with coeliac disease. Complete atrophy of the villi with flat mucosa and marked crypt hyperplasia. Intraepithelial lymphocytosis. Dense mixed inflammatory infiltrate in the lamina propria.
Duodenal biopsy from a patient with coeliac disease. Flat mucosa with hyperplastic crypts and dense cellular infiltrate in the lamina propria. Increased number of intraepithelial lymphocytes and vacuolated superficial epithelial cell vacuolated superficial epithelial cells. Higher magnification image on the right.
