Coeliac

Question 1

What is coeliac disease?

Answer 1

It is a chronic inflammatory disease of the upper small intestine that occurs as a result of
gluten intolerance due to genetics

Question 2

Why is coeliac disease under-diagnosed?

Answer 2

It presents for a wide range of clinical features. They have minimal symptoms and is often
thought to be associated with IBS symptom.

Question 3

What is gluten?

Answer 3

A protein present in wheat, rye and barley, cereals, pasta, flours, and cakes

Question 4

Who is it more common in?

Answer 4

Females in a 3:1 ratio

Question 5

What is the pathophysiology of coeliac disease?

Answer 5

The patient ingests gluten which activates T-cells in the small intestine. These T-cells react
with tissue transglutaminase (a key component of the endomysium autoantigen – it is a
connective tissue that surrounds the intestinal smooth muscle. The endomysium
autoantigen is then surrounded by a layer of villi which surrounds the entire small intestine.
The purpose of the villi is to absorb nutrients and increase its surface for absorption.) which
go on to release inflammatory mediators. The inflammatory mediators attack the villi which
causes villous atrophy of the small intestine. This means shrinkage/ erosion of the villi
causing the villi to go flat and it then unable to absorb nutrients and there is damage to the
surface.

Question 6

What are the symptoms of coeliac disease?

Answer 6

Symptoms in 2 years and under:
- diarrhoea
- failure to thrive (hair thinning, low weight, lack of fat)
- anorexia and vomiting
- pyschomotor impairment ( muscle wasting)
- abdominal distension ( enlarged abdomen)

Childhood
- anaemia
- diarrhoea or constipation
- loss of appetite

Adults
- diarrhoea and constipation
- anaemia
- abdominal pain, dyspepsia, weight loss,
- bone pain (osteoporosis)
- fatigue, infertility, neuropsychiatric symptoms (anxiety and depression)

Question 7

What condition occurs as a result of coeliac disease and who is it more common in?

Answer 7

Dermatitis herpetiformis – skin condition more common in 50-69 years

Question 8

8. What diseases are associated with coeliac diseases?

Answer 8

Type1 diabetes, thyrotoxicosis (hyperthyroidism) , epilepsy, osteoporosis, undefined neurological disorder and
immune deficiency (IgA deficiency)

Question 9

9. How do we investigate coeliac disease?

Answer 9

Duodenal biopsy (biopsy of the small intestine), serological markers including IgG, IgA and
EMA antibodies
The biopsy needs to show there is villous of the villi. The clinician needs to explain to the
patient to continue eating a gluten diet for a period of 6 weeks roughly and then perform a
biopsy. Then the patient is told to stop eating gluten for a period of 6 weeks to show there is
improvement in atrophy of the villi.

Question 10

10. Why is coeliac disease a problem?

Answer 10

s a lifelong intolerance to gluten within foods and can cause small bowel cancer,
osteoporosis, depression in adults, and short stature in children

Question 11

11. What is the management plan for coeliac disease?

Answer 11

A strict gluten free diet, nutritional supplements such as iron, folic acid, and calcium, also monitor dietary adherence by serial tests for antiendomysial and antigliadin antibodies.
Regular consultation with a trained dietician and repeat intestinal biopsy if progress is suboptimal

Question 12

Is gluten free food available on FP10?

Answer 12

Bread and flour mixes only