Coeliac's Disease Flashcards
def
inflammatory disease caused by intolerance to gluten, causing chronic intestinal malabsorption
aetiology
sensitivity to gliadin component of gluten
triggers an immune response in small intesting leading to mucosal damage & loss of villi
what haplotypes show genetic susceptibility for coeliacs disease
HLA-88
DR3
DQW2
epi
1 in 2000 prevalence in UK
more common in ireland
history
may be asymptomatic abdominal pain & distension steatorrhoea or diarrhoea weight loss despite normal diet failure to thrive in children amenorrhoea in young adults
what is steatorrhoea
fat in stool
pale bulky stool
offensive smell
examination
1 signs of anaemia (pallor)
2 signs of malnutrition (short stature, abdominal distension, wasted buttocks in children)
3 signs of vitamin/mineral deficiencies (osteomalacia, easy bruising)
4 dermatitis herpetiformis (itchy blisters on elbows/knees/buttocks)
investigations
1 bloods
-FBC (low Hb)
-microcytic RBCs (low iron)
2 serology
-IgG anti-gliadin (AGA), IgA & IgG anti-endomysial transglutaminase can be diagnostic
3 stool
-culture to exclude infection
4 D-xylose test
-reduced urinary excretion after an oral xylose load indicates small bowel malabsorption
5 endoscopy
-shows villous atrophy especially in the jejunum & ileum, which gives a flat smooth appearance
-biopsy shows villous atrophy with crypt hyperplasia of the duodenum
-epithelium has a cuboidal appearance
management
advice -avoid gluten (wheat, rye, barley) medical -vitamin & mineral supplementation -oral corticosteroids if disease does not subside with gluten withdrawal
complications
iron, folate, vitB12 deficiency
osteomalacia
ulcerative jejunoileitis
GI lymphoma (particularly T cell)
prognosis
complete avoidance of gluten (for life) usually leads to full recovery
symptoms resolve rapidly, histological changes take longer
