Coeliac Disease

Question 1

What is coeliac disease?

Answer 1

A T-cell mediated autoimmune disease where exposure to gluten results in inflammation of the small intestine.

Question 2

What does inflammation of the small intestine result in?

Answer 2

Particularly jejunum –> villous atrophy + malabsorption

Question 3

2 peaks of presentation?

Answer 3

(1) Infancy

(2) 50-60 yrs

Question 4

Which 2 auto-antibodies are created in response to gluten and attack epithelial cells?

Answer 4

(1) anti-tissue transglutaminase (anti-TTG)

2) anti-endomyseal (anti-EMA

Question 5

Sign in young children?

Answer 5

Failure to thrive or weight loss

Question 6

GI symptoms?

Answer 6

• Abdo pain + distension
• N&V
• diarrhoea, steatorrhoea
• fatigue, weakness, weight loss

Question 7

General appearance?

Answer 7

(1) pallor - anaemia?
(2) SHORT STATURE + WASTED BUTTOCKS
(3) vit deficiencies

Question 8

Dermatological manifestation?

Answer 8

Dermatitis herpetiformis (ITCHY papulovesiclar lesions over bum + extensor surfaces)

Question 9

Which new diagnosed patients would you screen for coeliac disease?

Answer 9

T1 Diabetes

Question 10

Associated diseases?

Answer 10

(1) T1 Diabetes
(2) AI - Graves disease or Hashimotos thyroiditis
(3) PBC, PSC

Question 11

Complications if untreated?

Answer 11

(1) Anaemia - iron deficiency
(2) vitamin deficiencies - B12, folate
(3) Osteoporosis
(4) Enteropathy-associated T-cell lymphoma (EATL)
(5) Non-Hodgkins lymphoma
(6) Small bowel adenocarcinoma (rare)
(7) Hyposplenism
(8) Lactose intolerance

Question 12

Most common genetic association?

Answer 12

(1) HLA-DQ2 (90%)

Also HLA-DQ8

Question 13

Initial Investigations?

Answer 13

Serological testing (remain eating gluten for 6 weeks):

1) IgA-TTG (w/ total IgA
(2) IgA-EMA

Question 14

What test would you carry out initially if the patient was IgA deficient?

Answer 14

IgG-TTG, IgG-EMA

Question 15

Gold standard investigation to confirm diagnosis after positive serology?

Answer 15

OGD w/ jejunal/duodenal biopsy

Question 16

What would histology of biopsy show?

Answer 16

(1) Villous atrophy
(2) Crypt hyperplasia
(3) Intra-epithelial lymphocytes

Question 17

Investigation to rule out infection?

Answer 17

stool culture

Question 18

Bloods?

Answer 18

FBC (anaemia)
U&Es + bone profile (vit D)
LFTs (albumin)
Iron, B12, folate

Question 19

Management?

Answer 19

Life-long gluten free diet

Dapsone if dermatitis herpetiformis

Question 20

What vaccine required, why?

Answer 20

(1) Pneumococcal (booster every 5 years)
(2) Influenza (yearly)
- ->Due to hyposplenism (immunosuppressed)

Question 21

What foods to avoid?

Answer 21

Wheat (bread, pasta, pastry)
Barley (beer)
Rye
Oats (contaminated)

Question 22

Where is B12 absorbed? What does it require?

Answer 22

Terminal ileum - requires intrinsic factor

Question 23

Where is folate absorbed?

Answer 23

duodenum + jejunum

Question 24

Where is iron absorbed?

Answer 24

Duodenum mainly