Coeliacs

Question 1

What causes coeliacs?

Answer 1

Autoimmune T4 hypersensitivity to gluten in small intestine

Question 2

What makes someone more susceptible?

Answer 2

HLA DQ2 + DG8 susceptible HLA people

Question 3

Which part of the GIT tract does coeliacs affect?

Answer 3

Small intestine
(mainly duodenum)

Question 4

What is coeliacs associated with?

Answer 4

Thyroid disorders and Addisons

Question 5

Pathology behind coeliacs

Answer 5

Wheat and grains –> Gluten (gliadin) –> immune cells (attack cells of small intestine & produce autoantibodies ahaint ttG)

Prolamins in gluten (alpha gliadin) interacts with ttG (tissue transglutaminase)
Results in formation of lots of Ig A, Ig A anti ttG, Endomysial (EMA) Ab - same as ttG

Question 6

Symptoms of Coeliacs

Answer 6

Haematinic deficiency (Fe, B12, folate) - Anemia
Steatorrhoea - high fat excretion in stool (not absorbed)
Diarrhoea
Weight loss + failure to thrive

Dermatitis Herpetiformis - Red bumpy skin rash on skins + knees due to IgA skin deposition

Question 7

Diagnosis of coeliacs

Answer 7

Serology (1st line) = Anti ttG Ab (best, most specific)
High total IgA - may get false negative in IgA deficient Px
(2nd line = high EMA)

Duodenal Biopsy (GS - DIAGNOSTIC)
Crypt hyperplasia (longer crypts)
Villous atrophy (flattened villi) = SPRUE
Epithelial lymphocyte infiltration

Question 8

When are the results on the serology and duodenal biopsy seen?

Answer 8

When patients consistently eat gluten

Question 9

Treatments of Coeliacs

Answer 9

V easy, STOP EATING GLUTEN
(+ replace vitamins/mineral deficiency)

*monitor osteoporosis with DEXA scans

Question 10

Tropical Sprue
what is it associated with?
What is seen?
Treatment?

Answer 10

Enteropathy associated with tropical travel

Produces similar ‘sprue’ biopsy to coeliac - crypt hyperplasia + villous atrophy

Tx: Often responds to Abx (eg. tetracycline)