GI - Coeliac Disease

Question 1

Definition

Answer 1

Coeliac disease is a systemic autoimmune disease triggered by dietary gluten peptides that causes inflammation in the small bowel

Question 2

Epidemiology

Answer 2

Genetic associations: HLA-DQ2 (90%), HLA-DQ8
Females more likely affected

Question 3

Aetiology

Answer 3

Autoimmune disorder triggered by gluten peptides from grains including wheat, rye, and barley
Additional environmental factors, and genetic pre-dispositions

Question 4

Symptoms

Answer 4

● Failure to thrive
● Diarrhoea
● Fatigue
● Weight loss
● Mouth Ulcers
● Steatorrhea
● Short stature and wasted buttocks
● Anaemia secondary to iron, B12 and folate deficiency
● Dermatitis herpetiformis- itch blistering rash that typically appears on the abdomen
● Rarely coeliac disease can present with neurological symptoms: Peripheral neuropathy, cerebellar ataxia, epilepsy

Question 5

Investigations

Answer 5

First line = FBC and Blood smear- low Hb and microcytic hypochromic red cells (IDA)
- IgA-tTG- titre above normal range Anti tTG IgA antibodies- (first choice)
- Anti-Endomysial antibody (EMA)- elevated titre
- Skin biopsy for skin lesions suggestive of dermatitis herpetiformis
- Histology- crypt hypertrophy and villous atrophy and intraepithelial lymphocytes
GS = OGD - Duodenal or Jejunal biopsy

Question 6

Management

Answer 6

Gluten free diet (vitamin and mineral supplementations)

Question 7

Complications

Answer 7

Vitamin deficiency,
Anaemia,
Osteoporosis,
Ulcerative jejunitis,
Non-Hodgkin lymphoma,
Small bowel adenocarcinoma

Question 8

Risk factors

Answer 8

FHx,
Immunoglobulin A deficiency, DMT1,
Autoimmune thyroid disease