Coeliac Disease

Question 1

what is coeliac disease

Answer 1

autoimmune condition which results in a sensitivity to gluten, causing inflammation as well as villi atrophy

Question 2

what can coeliac disease lead to

Answer 2

chronic intestinal malabsorption

Question 3

aetiology

Answer 3

the body is sensitive to gliadin which is a component of gluten; ingestion leads to an immunological reaction in the small bowel which leads to villi atrophy as well as mucosal damage

Question 4

risk factors

Answer 4

family Hx as there is genetic susceptibility (10% first degree)
type 1 diabetes and autoimmune thyroid (autoimmune diseases make you more susceptible to more autoimmune conditions)
IgA deficiency

Question 5

epidemiology of coeliac disease

Answer 5

UK; 1/2000
Western Ireland; 1/300
East Asia; rare

Question 6

Presenting symptoms of coeliac disease

Answer 6

bloating, abdominal discomfort, pain and abdominal distension, steatorrhoea, diarrhoea, tiredness, malaise and unintentional weight loss, failure to thrive in children, amennhorea in young adults, osteopenia and osteoporosis

Question 7

can coeliac disease be asymptomatic

Answer 7

yes

Question 8

what is steatorrhoea

Answer 8

too much fat in faeces, white bulky stool, offensive smell and more difficult to flush

Question 9

Physical Examination findings

Answer 9

signs of anaemia (pallor),
signs of malnutrition (short stature, abdominal distension, wasted buttocks in children)
signs of vitamin and mineral deficiency (osteomalacia and easy bruising)
dermatitis herpetiformis

Question 10

what vitamin deficiency leads to osteomalacia

Answer 10

D

Question 11

what vitamin deficiency leads to easy bruising

Answer 11

C and K

Question 12

what investigations will be done to diagnose Coeliac disease

Answer 12

bloods, serology, stool tests, endoscopy and biopsy

Question 13

what would you look for in bloods

Answer 13

FBC, U&E’s, albumin, calcium (osteoporosis is a complication and leads to low calcium), phosphate (high phosphate)

Question 14

serology investigation

Answer 14

IgG anti-gliadin antibodies (IgAandG anti-endomysial antibodies can be diagnostic factors for coeliac and dermatitis herpetiformis)

Question 15

why don’t you rely solely on IgA levels

Answer 15

IgA deficiency is quite common (1/50) and won’t always mean the patient is coeliac

Question 16

stool test

Answer 16

culture to check for bacterial infection and also do faecal fat tests for steatorrhea

Question 17

D-xylose test

Answer 17

if there is reduced urinary output when a patient takes oral xylose, it indicates small bowel malabsorption

Question 18

Endoscopy and Biopsy

Answer 18

will show villous atrophy and crypt hyperplasia. epithelium will appear cuboidal due to inflammation

Question 19

management

Answer 19

advice; avoid gluten - wheat, barley and rye

medical; vitamin and mineral supplements. oral corticosteroids if disease doesn’t subside with gluten-free diet

Question 20

possible complications

Answer 20

iron, folate, B12 deficiency 
osteomalacia, 
ulcerative jejunoilelitis
GI lymphoma,
bacterial overgrowth 
and in RARE cases, cerebellar ataxia

Question 21

prognosis

Answer 21

full recovery if gluten-free diet is stuck to for life. takes weeks for symptoms to improve after dietary change