Gastro - Coeliac Disease in Children Flashcards
What is coeliac disease?
Autoimmune reaction to the gliadin faction in gluten
What are the key auto-antibodies in coeliacs?
Anti-TTG
Anti-EMA
(less common anti-DGP)
What part of the bowel is particularly affected in coeliacs?
Jejunum
Causing villous atrophy and crypt hypertrophy
Leads to malabsorption
How does coeliacs present?
Often asymptomatic so low threshold for testing where suspected
- Failure to thrive
- Diarrhoea
- Fatigue
- Weight loss
- Mouth ulcers
- Anaemia
- Dermatitis herpetiformis
What are some rare presentations of coeliacs?
Neurological symptoms
- Peripheral neuropathy
- Cerebellar ataxia
- Epilepsy
What condition once diagnosed do you always test for coeliacs after?
Type 1 diabetes
Highly linked
What genes are affected in coeliacs?
HLA-DQ2 (90%)
HLA-DQ8
Why do you test for total IgA levels when testing for coeliacs?
Anti-TTG and anti-EMA are IgA antibodies
If the patient has a deficiency of IgA, coeliacs test will be negative
In this case, test for IgG version or do endoscopy with biopsies
How is Coeliacs diagnosed?
Investigations must be carried out while patient remains on gluten diet otherwise may not be possible to detect antibodies or inflammation
Bloods
- Check total IgA levels
- Raised anti-TTG (first choice)
- Raised anti-EMA
Biopsy
- Crypt hypertrophy
- Villous atrophy
What conditions are associated with coeliacs?
Type 1 Diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Down’s syndrome
What are the complications if coeliac disease is untreated?
Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL) of the intestine
Non-Hodgkin lymphoma
Small bowel adenocarcinoma
How is coeliacs treated?
Lifelong gluten free diet
