Gastro - Coeliac disease

Question 1

what is the pathophysiology of CD?

Answer 1

Immune-mediated, inflammatory systemic disease provoked by gliadin component of gluten in genetically susceptible people.

Immune response results in GI epithelium damage: villous atrophy, deepening of crypts and lymphocyte invasion of epithelium.

Question 2

describe and expain the common features of CD

Answer 2

1. diarrhoea +/- steatorrhoea: increased osmotic load from lack of carb and protein digestion
2. weight loss and fatigue: nutrient, mineral and fat-soluble vitamin malabsorption
3. flatulence and bloating: increased bacterial fermentation
4. abdo pain and cramping
5. sensory loss in hands (peripheral neuropathy), other neurological symptoms, inc. migraine: toxin malabsorption

Question 3

which Ix should be performed in a pt with suspected CD

Answer 3

1. Bloods
   - total IgA and IgA tTG
   - FBC: anaemia in 50%
   - vitB12, folate and ferritin: ?deficiency
   - calcium: ?deficiency
   - LFTs: may show raised transaminases which should return to normal on GFD

Question 4

how would you manage a pt with CD

Answer 4

lifelong strict GFD

Question 5

describe possible complications of untreated CD

Answer 5

1. nutrient deficiencies, e.g. vitD and iron
2. osteoporosis
3. small bowel adenocarcinoma and lymphoma
4. ulceratitive jejunitis and strictures (long0standing)
5. functional hyposplenism/splenic atrophy
6. infertility and poor foetal outcome (resolves on GFD)