IBD, Coeliac Flashcards
Coeliac Clinical presenatation
- Diarrhoea
- Sx of malabsorption - LOA, anaemia, Vit B12/D def, osteopenia, steatorrhea
Vilious atrophy
Dermatitis herpetiformins - itchy rash on forearms, knees, scalp, buttocks
Atrophic glossitis
Diagnosis - Coeliac
- Genetic Testing HLADQ2 - 90-95% patients HLADQ 8 - 5% but its prevalent in population
Good for negative testing or to exclude diagnosis Can use if on gluten free diet - Serological testing
a. TTG IgA and IgA levels OR
b. TTG IgA and deaminated gliadin IgG if positive, then test EMA-IgA if TTG >10 ULN + EMA-IgA -+ve then no need bx, if <10ULN then do biopsy
Need to be on gluten diet prior to diagnosis
Selective IgA deficiency - more common in Coeliac disease - need to use IgG isotype
- Histo - gold standard
Autoimmune disease a/w coeliac
Autoimmune thyroid disease
T1DM
PSC, PBC
autoimmune hepaittis
NAFLD
Sjogren’s
Addisons
Downs syndrome etc
Refractory coeliac Definition Treatment
persistent malapsorbton or villous atrophy after gluten free diet >12m Mx - Immunosuppression or chemo
Immune cell responsible for coeliac disease
T cells Gluten –> deaminated by enzyme TTG –> becomes immunogenic –> binds to HLA DQ2/8 –> stimulate T cells
Crohns disease Features - GI
Features - abdominal pain, diarrhoea, systemic symptoms
Skip lesions, mouth –> anus
Goblet cells, granulomas
Bowel obstruction, fistulae
Perianal disease - pain, abscess
Crohns disease
Genetic predisposition and pathophysiology of genetic mutation
NOD2/ CARD 15 variants
NOD2 gene on chromosome 16 –> NOD2 intracellular pattern recognition receptor which recognized molecules containing “muramyl dipeptide (MDP) which is found in certain bacteria
Triggers immune response –>inflammatory response
MDP - found in GNB and GPC
Strong familial association
Crohns disease Features - non GI
Erythema nodosum
pyoderma gangrenous
PSC - colangitis
Malabsorbtion
uveitis, iritis, episcleritis
Bronchiectasis
Arthritis
cronhs Ix
Faecal calprotectin - elevated Scope - focal ulceration, cobblestone, skip lesions, granulomas, crypts Complications ie abscess, stricture, fistula -MRI + enterography -CTE
Cronhs Severity index - factors
- Smoker
- Elevated CRP
- Systemic sx - LOA, LOA, abdo pain, n/v, anaemia, fever
- Ulcecrs
- Perianal disease
- Hx of resection
- Deep ulcers on scope
- Young age at diagnosis
Truelove and Witt
Management
- Mild disease
- Moderate disease
- Severe disease
- Mild disease
- Corticosteroids for up to 3-6 months - Moderate disease
- Pred 40-50mg until clinical response, taper over 6-8 weeks - Severe disease
- Hydrocort 100mg QID IV or burst methylpred
other options: Aza, Mercaptopurine, MTX (takes 2-3 months to work)
No response/sevvere disease
-Infliximab or adalimumab or Vedolizumab
If failus - Ustekinumab (IL12/23 - used in PsA)
Maintainence - AZA, Mercaptopurine, MTX
Vedolizumab
monoclonal antibody - binds to intergrin –> reduced inflammation by reducing binding of T lymphocytes to gut tissues
Infliximab
drug
C/I
anti TNF
C/I - Heart failure, demyelinating disease
Surgical Complications
