Gastro - Coeliac Disease Flashcards
What is Coeliac disease?
Autoimmune condition due to the gliadin faction in gluten
What is Coeliac disease linked to?
Type 1 diabetes
Thyroid disease
All new T1DM patients are tested for Coeliac disease
What is the pathophysiology of Coeliac disease?
Autoantibodies created in response to exposure to gliadin faction of gluten
Autoantibodies target the epithelial cells of the small intestine leading to inflammation
What are the autoantibodies in Coeliac disease?
Anti-tissue transglutaminase antibodies (anti-TTG)
Anti-endomysial antibodies (anti-EMA)
Anti-deamidated gliadin peptide antibodies (anti-DGP)
Where in the bowel is affected by Coeliac disease?
Small bowel
Particularly the jejunum
Atrophy of intestinal villi causing malabsorption
What genotypes is Coeliac disease associated with?
HLA-DQ2
HLA-DQ8
How does Coeliac disease present?
Often asymptomatic and under-diagnosed, so low threshold for testing in suspected patients
- Failure to thrive in young children
- Diarrhoea
- Bloating
- Fatigue
- Weight loss
- Mouth ulcers
Dermatitis herpetiformis
Itchy, blistering skin rash on the abdomen caused by Coeliac disease
Anaemia
Malabsorption of iron, B12 or folate
What are some rare presentations of Coeliac disease?
Peripheral neuropathy
Cerebellar ataxia
Epilepsy
How is Coeliac disease diagnosed?
Patient must continue eating gluten while being investigated
Antibodies may be normal if patient is gluten free
First-line blood tests
- Total immunoglobulin A levels (IgA deficiency)
- Anti-TTG levels
Second line
- Anti-EMA if there is doubt
Why is it important to test for total immunoglobulin A levels?
Anti-TTG and anti-EMA are IgA
If patients have IgA deficiency, these antibodies may be low or normal
Can test for IgG version of anti-TTG and anti-EMA if low
What are the typical biopsy findings in Coeliac disease?
Crypt hyperplasia
Villous atrophy
How is Coeliac disease managed?
Lifelong gluten-free diet
What are the complications of Coeliac disease?
Nutritional deficiencies
Anaemia
Osteoporosis
Hyposplenism
Ulcerative jejunitis
Enteropathy-associated T-cell lumphoma
Non-Hodgkin lymphoma
Small bowel adenocarcinoma
