Coeliac's Disease

Question 1

What are the three typical appearances of a gut with Coeliac’s

Answer 1

Villus atrophy, crypt hyperplasia and increased number of intra-epithelial lymphocytes

Question 2

What is the Immune pathogenesis of Coeliac’s Disease

Answer 2

• Once gliadin has been deaminated, it can be presented on either DQ2 or8
• This will activate CD4+ cells to produce IL-15, helps to induce yd CD8+ T cells to upregulate certain receptors
• Presence of IFNy secreted by CD4+ will cause the upregulation of MIC -a and MIC-b on villus epithelial cells
• Now yd CD8+ T cells can detect the presence of MIC -a and MIC-b and will induce apoptosis of these cells

Question 3

Diagnosis of Coeliac’s Disease

Answer 3

• B cells produce antigens against tTG and anti-gliadin yet not pathogenic but can be used as a clinical test
• Deaminated gliadin
• DQ haplotyping
• Small bowel biopsy after ingestion of gluten

Question 4

Common presentations of Coeliac’s

Answer 4

• Diarrhoea, foal smelling
• Bloating, flatulence
• Cramps
• Anaemia and vitamin deficiencies

Question 5

Best treatment for coeliacs

Answer 5

Don’t eat gluten

Question 6

Long term complications of undiagnosed Coeliac’s

Answer 6

If not diagnosed can increase the risk of small bowel lymphoma (EATL or enteropathy assocaited T cell lymphoma)
Increased risk for SI adenocarcinoma
Oesophageal cancer