Coeliac Disease (yeet)

Question 1

What is coeliac disease?

Answer 1

Autoimmune reaction to a constituent of wheat flour, gluten, which damages enterocytes and reduces absorptive capacity.

Question 2

What is gliadin and what does it do?

Answer 2

Component in gluten which triggers an immune response mediated by T cell lymphocytes which exist in the SI epithelium.

Question 3

What is the result of Gliadin triggering immune response?

Answer 3

There is tissue damage as a result of this, causing an increasing loss of enterocytes due to intraepithelial lymphocyte mediated damage, leading to loss of villous structure, loss of SA and reduction in absorption and a flat duodenal mucosa

Question 4

Who gets coeliac disease?

Answer 4

Genetic disposition 
When gluten is introduced into the diet is significant 
Rotavirus in infancy increases risk 
Female predominance 
Peak diagnosis in 5th decade 
All IBS patients tested

Question 5

How does coeliac disease present?

Answer 5

• All ages
• Many asymptomatic (found in blood test)
• Tiredness/malaise= main
• Diarrhoea/steatorrhoea/ abdo pain
• Wt loss
• Anaemia
• Mouth ulcera/ angular stomatitis
• Infertility, neuropsychiatric symptoms (depression/anxiety)
• Failure to thrive

Question 6

How is coeliac diagnosed?

Answer 6

• Gold standard= Small bowel biopsy

- Serology

Question 7

What you would see in coeliac disease endoscopy?

Answer 7

-Absence of mucosal folds, mosaic pattern, scalloping of mucosal folds

Question 8

When to do serology?

Answer 8

If persistent diarrhoea, folate or iron deficiency, unexplained abnormal liver biochem, FHx of Coeliac

Question 9

What other tests should be done when Coeliac is suspected?

Answer 9

Blood test for anaemia + nutrient deficiency
Osteomalacia
Ba swallow & MRI imaging to see SI dilation, thickening of walls, or slow transit time
Bone densitometry- assess osteoporosis risk
Capsule endoscopy

Question 10

How is Coeliac treated?

Answer 10

Gluten free diet (food can be prescribed)
Replacing minerals and vitamins (iron, follate, Ca, VitC)
Need to have pneumococcal vaccinations every 5 years

Question 11

Side effects of Coeliac Disease?

Answer 11

Malabsorption of sugars, fats, amino acids, water and electrolytes
Reduced intestinal hormone production leads to reduced pancreatic secretions and bile flow leading to gallstones
Loss of weight
Anaemia
Abdo bloating
Failure to thrive

Question 12

Malabsorption of fats leads to?

Answer 12

Steatorrhea

Question 13

Complications of Coeliac?

Answer 13

T cell lymphomas 
Increased risk of SI carcinoma 
Gall stones 
Tetany 
Ulcerative Jejunitis: fever, abdo pain, perforation, bleeding 
Osteomalacia/porosis 
Peripheral oedema 
Risk of SI adenocarcinoma

Question 14

2 antibodies to remember for coeliac disease?

Answer 14

Anti tissue transglutaminase (anti TTG)

Anti-endomysial (anti-EMA)

Question 15

What type of patient do you always test for coeliac?

Answer 15

New cases of type 1 diabetes even if they don’t have symptoms

Question 16

Associated genes with coeliac?

Answer 16

HLA-DQ2

HLA-DG8

Question 17

What must you check before testing someone doesn’t have coeliac disease?

Answer 17

Ensure they don’t have a IgA deficiency

Check total IgA levels

Question 18

What will be raised in Coeliac?

Answer 18

Raised anti-TTG (1st choice)

Raised anti-endomyosial ABs

Question 19

Endoscopy shows?

Answer 19

Villus atrophy

Crypt hypertrophy

Question 20

What other disease is coeliac associated with?

Answer 20

Type 1 diabetes 
Thyroid disease
AI hepatitis 
Primary Biliary cirrhosis 
Primary sclerosing cholangitis