Coeliac's disease

Question 1

Define:

Answer 1

An inflammatory disease caused by an intolerance to gluten. This leads to chronic malabsorption.

Leads to subtotal villi atrophy and crypt hyperplasia.

Question 2

Aetiology/risk factors:

Answer 2

• Due to sensitivity to the GLIADIN component of the cereal protein, gluten triggering an immunological reaction in the small intestine leading to mucosal damage and loss of villi – lose ability to absorb hence diarrhoea and weight loss

the damage is REVERSIBLE if gluten is avoided
• 10% risk of first-degree relatives being affected
• Clear genetic susceptibility associated with HLA-B8, HLA-DR3 and HLA-DQW2 haplotypes

Question 3

Symptoms:

Answer 3

usually asymptomatic. 
Abdo pain, distension and discomfort. 
Diarrhoea
Weight loss 
Steatorrhea
Tiredness 
Malaise
Failure to thrive in children
Ammenhorea

Question 4

Signs:

Answer 4

Signs of anaemia such as pallor.

Signs of malnutrition such as wasted buttocks in children, abdo distention, short stature + decreased thickness of triceps fold.

Signs of vitamin and mineral deficiency: osteomalacia, easy bruising

Intense itchy blisters on knees, elbows and bum

Question 5

Epidemiology:

Answer 5

UK - 1/2000
West Ireland - 1/300
Rare in east Asia

Question 6

Investigations:

Answer 6

•	Blood: 
o	FBC (low Hb, iron and folate)
o	U&E
o	Albumin 
o	Calcium
o	Phosphate 
•	Serology:
o	IgG anti-gliadin antibodies, IgA and IgG anti-endomysial tranglutaminase antibodies can be diagnostic 

• Stool: culture to exclude infection, faecal fat tests for steatorrhoea
• D-xylose test: reduced urinary excretion after oral xylose indicates small bowel malabsorption
• Endoscopy: allows direct visualisation of villous atrophy in the small intestine (mucosa appears flat and smooth)

Question 7

Management:

Answer 7

• Advice: avoid gluten (wheat, rye and barley products), education, dietary advice
• Medical: vitamin and mineral supplements. Oral corticosteroids if disease does not subside with avoidance of gluten

Question 8

Complications:

Answer 8

• Iron, folate and B12 deficiency
• Osteomalacia
• Ulcerative jejunoileitis
• GI lymphoma (particularly T cell) – if untreated coeliac
• Increased risk of gastric/oesophageal/bladder/breast/brain malignancy
• Bacterial overgrowth
• Cerebellar ataxia (rarely)

Question 9

Prognosis:

Answer 9

• FULL RECOVERY in most patients who strictly adhere to a gluten-free diet
• Symptoms usually resolve within weeks though histological changes may take longer
• Gluten-free diet must be followed for life