Coeliacs Disease Flashcards
Pathophysiology
Autoimmune reaction to gliadin factor in gluten
Associate conditions
Dermatitis herpetiform Iron deficiency anaemia (due to malabsorption and diarrhoea) Vitamin D deficiency Other autoimmune disorders: - T1DM - autoimmune hepatitis - thyroid disease
Genetic risk - genotyping
HLA- DQ2 (95%)
HLA - DQ8 (80%)
Antibody tests
Antibody test
- tissue transglutaminase IgA Ab
- endomyseal IGA Ab (exclude selective IgA deficiency)
- deaminated gliadin peptide IgA and IgG (not recommended )
Investigations
Bloods - FBC (identify iron deficiency anaemia)
Haematinics: Vit D, folate and B12
First line - IgA - tTG
- Anti-gliadin IgG persist with exclusion diet
Endoscopic intestinal biopsy during OGD - gold standard
Endoscopy findings
Blunted villi - villus atrophy
Crypt hyperplasia
Lymphocytic infiltration of epithelium and lamina propria
Actions before endoscopy
If on gluten free diet, patient needs to resume eating gluten 6+ weeks before biopsy
Management
Gluten free diet Dietician input Check nutritional deficiencies: - Fe - Vit D - Vit B12 - folate Pneumococcal vaccine and booster every 5 years
Why give pneumococcal vaccine
Functional hyposplenism therefore increased risk of infections by encapsulated bacteria
Treatment of dermatitis herpetiformis
Dapsone
Foods to avoid
Bread Beer Pasta Rye Oats
Foods can eat
Rice
Potatoes
Corn
Whisky
Complications of coeliacs
Dermatitis herpetiformis Osteoporosis GI carcinoma Pancreatitis Pneumococcal infections
Common presentation
Young
Caucasian
Nausea and Vomiting Diarrhoea Bloating and Abdomen discomfort Fatigue and weakness Flatus
Dermatitis herpetiform
Symmetrical vesicles on extensor surfaces
Esp. elbows
Very itchy
Responds to gluten-free diet or dapsone
Biopsy: granular deposition of IgA
Aphthous ulcers
