Coeliac Disease Flashcards

1
Q

Define coeliac disease

A

A systemic autoimmune disease that is triggered by dietary gluten peptides (gliadin part) found in wheat, rye, barley, and related grains

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2
Q

What is the aetiology of coeliac disease

A

T-cell response to gluten (alcohol-soluble proteins (gliadin) in wheat, barley, rye and oats).
Almost all carry HLA-DQ2 or DQ8
Mostly in the 2nd part of the duodenum. Leads to crypt hyperplasia, loss of villi

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3
Q

What are the risk factors for coeliac disease

A

Family history of coeliac disease (first degree 6x)
IgA deficiency
T1DM
Autoimmune thyroid disease
Autoimmune liver disease
Down’s syndrome
William’s syndrome
Sjogren’s
IBD
Primary biliary cirrhosis
Dermatitis herpetiformis

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4
Q

What is the epidemiology of coeliac disease

A

Any age, peaks in childhood and 50-60yrs
1:1 ratio of males to females OR 2/3 females
20% “silent”
1% develop refractory coeliac disease (persists despite a strict gluten free diet)

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5
Q

What are the symptoms of coeliac disease

A

Any age after weaning (6 months)

GI:
- Diarrhoea with foul smelling stools/steatorrhoea
- Abdominal pain
- Bloating
- Nausea and vomiting
- Ulcers on the mouth

Non GI
- Failure to thrive / faltering growth / short stature
- Delayed puberty or menarche
- Weight loss, weakness
- fatigue, irritability
- Dental enamel defects
- Osteoporosis and pathological fractures (vit D)
- itchy rash and dry skin (dermatitis herpetiformis)

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6
Q

What are the signs of coeliac disease on examination

A

General: osteomalacia, pallor (anaemia)
- Dermatitis herpetiformis (pruritic papulovesicular lesions that occur symmetrically over the extensor surfaces of the arms and legs + buttocks, trunk, neck and scalp)
Height and weight
Face: angular stomatitis, aphthous ulcers

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7
Q

What are the differentials for coeliac disease

A

Peptic duodenitis
Crohn’s disease
Giardiasis
Small intestinal bacterial overgrowth
Post-gastroenteritis
Tropical sprue
Common variable immune deficiency
Gluten-sensitivity

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8
Q

What investigations should be done for coeliac disease

A

Bedside: stool sample (negative culture) + faecal calprotectin (elevated)

Bloods:
- IgA (ensure no deficiency)]
- anti-transglutaminase (anti-tTG): raised
- FBC: Fe deficiency anaemia (↓Hb ↓MCV)
- Blood film: microcytic, hypochromic red cells, target cells, Howell-Jolly bodies (hyposplenism)
- endomysial antibody (EMA): raised
- LFTs: ↑AST/ALT
- Vit B12, iron, vit D, folate
- HLA-DQ typing

Other
- Endoscopy and biopsy (DIAGNOSIS): villous atrophy, crypt hyperplasia in SI (flat, smooth appearance)

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9
Q

What is the management for coeliac disease

A
  1. Gluten free diet (exclude wheat, barley, rye)
  2. Vitamin supplementation: vit D and calcium
  3. Immunisation: pneumococcal + booster every 5 years ± influenza

+Follow up - monitor symptoms and repeat serology to check adherence
+ annual blood tests (FBC, ferritin, TFTs, LFTs, B12, folate)
+ support: Coeliac UK

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10
Q

What is a coeliac crisis and what is the management

A

Usually due to a precipitating major medical event e.g. recent abdominal surgery

Hypovolaemia
Severe watery diarrhoea
Acidosis
Hypocalcaemia
Hypoalbuminaemia

Rehydration + correction of electrolyte abnormalities + corticosteroid e.g. budesonide 9mg orally once daily

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11
Q

What is the management of dermatitis herpetiformis

A

dapsone

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12
Q

Complications of coeliac disease

A

Anaemia
Impaired growth
Malnutrition, malabsorption
Later menses, amenorrhoea, infertility, and increased risk of miscarriage
Dermatitis herpetiformis
Osteopenia/osteoporosis
Hyposplenism
Increased risk of malignancy e.g. enteropathy-associated T cell lymphoma (EATL)
Neuropathies
Increased risk of renal, eye, and vascular complications in patients with type 1 diabetes and coeliac disease.

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13
Q

What is the prognosis for coeliac disease

A

Good prognosis
Up to 90% will have complete and lasting resolution of symptoms on a gluten-free diet alone
Ongoing gluten exposure, lactose intolerance and IBS account for 10% of the cases with persistent symptoms
Fewer than 1% of patients can be expected to develop refractory coeliac disease

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