Coeliac disease

Question 1

What is coeliac disease?

Answer 1

Coeliac disease is a T cell-mediated inflammatory autoimmune disease affecting the small bowel in which sensitivity to prolamin results in villous atrophy and malabsorption.

Question 2

What are the common ages for coeliac presentation?

Answer 2

Presentation is bimodal (in infancy and at age 50-60)

Question 3

What are risk factors for coeliac disease?

Answer 3

Positive family history, HLA-DQ2 allele, and other autoimmune disease (such as type 1 diabetes mellitus).

Question 4

What are the GI symptoms signalling coeliac disease?

Answer 4

Abdominal pain
Distension
Nausea and vomiting
Diarrhoea
Steatorrhoea

Question 5

What are the systemic symptoms signalling coeliac disease?

Answer 5

Fatigue
Weight loss or failure to thrive in children
Dermatological manifestations: dermatitis herpetiformis

Question 6

What are complications of coeliac disease?

Answer 6

Unexplained iron deficiency and anaemia

B12 or folate deficiency

Osteoporosis

Hyposplenism

Enteropathy-associated T cell lymphoma

Question 7

What is the histology of coeliac disease?

Answer 7

Sub-total villous atrophy

crypt hyperplasia

intra-epithelial lymphocytes.

Question 8

What is the gold standard test for coeliac disease?

Answer 8

Check the serum immunoglobulin (Ig)A tissue transglutaminase antibody (tTGA) and total IgA first-line

Question 9

What determines a patient with coeliac disease’s risk of developing enteropathy-associated T cell lymphoma?

Answer 9

Directly proportional to the strength of overall adherence to a gluten free diet