Coeliac disease

Question 1

Coeliac patients are intolerant to what protein?

Answer 1

Gluten

Question 2

Describe the pathophysiology of coeliac disease

Answer 2

Repeated exposure leads to villous atrophy
=> causes malabsorption

It is strongly associated with HLA-DQ2 (95% of patients) and HLA-DQ8 (80%).

Question 3

Name other conditions often associated with coeliac disease

Answer 3

dermatitis herpetiformis

autoimmune disorders:
- type 1 diabetes mellitus
- autoimmune hepatitis
- autoimmune thyroid disease

Question 4

Coeliac disease is associated with which HLA groups?

Answer 4

HLA-DQ2
HLA-DQ8

Question 5

Clinical features of coeliac disease

Answer 5

• Chronic/intermittent diarrhoea
• Failure to thrive or faltering growth (in children)
• Unexplained N+V
• Fatigue
• Abdo cramp/distension
• weight loss
• iron deficiency anaemia or other anaemia

Question 6

Complications of coeliac disease

Answer 6

• anaemia: iron, folate and vitamin B12 deficiency
• hyposplenism
• osteoporosis/ osteomalacia
• lactose intolerance
• enteropathy-associated T-cell lymphoma of small intestine
• subfertility

Question 7

Describe the histological appearance of the duodenum in coeliac disease

Answer 7

• Villous atrophy
• flat mucosa
• crypt hyperplasia
• Intraepithelial lymphocytosis
• inflammatory lymphocytes in lamina propria

Question 8

What are the two investigations which can confirm a diagnosis of coeliac

Answer 8

• IgA serology - tissue transglutaminase (TTG) antibodies
• intestinal biopsy.

Question 9

For how long before an IgA serology blood test should patients be eating foods containing gluten

Answer 9

If patients are already taking a gluten-free diet they should reintroduce gluten for at least 6 weeks prior to testing.

Question 10

What part of the small intestine can be biopsied for a diagnosis of coeliac?

Answer 10

usually duodenum but jejunal biopsies are also sometimes performed

Question 11

Villous atrophy and immunology normally reverses on a gluten-free diet. TRUE/FALSE

Answer 11

TRUE
=> patient may need to reintroduce gluten for short period before testing

Question 12

Name some foods that are naturally gluten free

Answer 12

rice
potatoes
corn (maize)

Question 13

Why are patients with coeliac disease recommended to have the pneumococcal vaccine?

Answer 13

often have a degree of functional hyposplenism