Gastroenterology: Coeliac Disease

Question 1

Describe the blood results for a patient with Coeliac [4]

Answer 1

normocytic anaemia: causes malabsorption of iron, folate and B12 - compensates to make normocytic

Raised WCC and CRP

Positive for IgA-tTG

Positive for endomysial antibody (EMA): a more expensive alternative to IgA-tTG

Question 2

Why can patients have false negatives on a celiac disease antibody test when investigating for coeliac?

Answer 2

May be suffering from IgA deficiency: so IgA-tTG may not be positive

IgA deficiency is significantly more common in people with coeliac disease than in the general population.

Question 3

What is the seroligcal test of choice for a coeliac patient with IgA defiency? [1]

Answer 3

IgG DGP (deamidated gliadin peptide)

Question 4

Explain why you would perfom a skin biopsy for a coeliac patient? [1]
Explain the pathophysiology of this disease [1]

Answer 4

test initially in any patient with skin lesions suggestive of dermatitis herpetiformis:
- caused by granular deposits of IgA at the dermal papillae of lesional and perilesional skin by direct immunofluorescence

Question 5

How would small bowel endoscopy appear in some coeliac patients? [1]

Answer 5

atrophy and scalloping of mucosal folds; nodularity and mosaic pattern of mucosa

Question 6

What three histoligcal findings would indicate coeliac?

Answer 6

presence of intra-epithelial lymphocytes
villous atrophy
crypt hyperplasia

Question 7

There is a link between coelaic and which other autoimmune diseases? [2]

Answer 7

DMT1 and thyroid disease

TOM TIP: Remember for your exams that we test all new cases of type 1 diabetes and autoimmune thyroid disease for coeliac disease, even if they do not have symptoms.

Question 8

Which three antibodies are related to coeliac? [3]

Answer 8

Anti-tissue transglutaminase antibodies (anti-TTG)
Anti-endomysial antibodies (anti-EMA)
Anti-deamidated gliadin peptide antibodies (anti-DGP)

Question 9

Which HLAs is coliac particularly associated with? [2]

Answer 9

HLA-DQ2
HLA-DQ8

Question 10

Name 5 symptoms of coeliac [6]

Answer 10

Often goes undiagnosed !

diarrhoea
bloating
abdominal pain/discomfort
anaemia
failure to thrive in children
Mouth ulcers

Question 11

The first line blood test is for Anti-tissue transglutaminase antibodies (anti-TTG) and what else? [1]

Answer 11

Total immunoglobulin A levels (to exclude IgA deficiency)

Question 12

Patients with a positive antibody test are referred to a gastroenterologist to confirm the diagnosis by [] and []

Answer 12

Patients with a positive antibody test are referred to a gastroenterologist to confirm the diagnosis by endoscopy and jejunal biopsy.

Question 13

Coeliac disease can effect which organ? [1]

Why is this clinically significant? [3]

Answer 13

Causes hyposplenism: means that patients are at risk of:
- Pneumococcus
- Haemophilus influenzae
- meningococcus

Question 14

Name [1] and explain [3] an MSK complication of coeliac.

Answer 14

Osteoporosis: Reduced bone mineral density is common in coeliac disease and often improves significantly within 1 year of gluten withdrawal.

Occurs due to:
* release of pro-inflammatory cytokines
* calcium malabsorption
* activation of osteoclasts

Question 15

Describe the stool of untreated coeliac patients [1]

Answer 15

Often greasy due to fat malabsorption

Question 16

Which cancer is associated iwth coeliac? [1]

Answer 16

Enteropathy associated T cell lymphoma of smal intestine

Question 17

Why may coeliac disease lead to fat malabsorption? [2]

Answer 17

Decrease in absorptive surface area

Decrease in absorption of fat soluble vitamins: ADEK

Question 18

Describe what is meant by refractory coeliac disease [1]

Describe the two classifcations [2]

Answer 18

Refractory coeliac disease: persistent or recurrent symptoms and signs of malabsorption despite adherence to a strict gluten-free diet for at least 12 months. Believed to be independent of gluten since the gluten-free diet is not effective in preventing the lymphocytes from increasing.

Type I:
- Have < 20% abnormal lymphocytes

Type II:
- Have >20% abnormal lymphocytes

Question 19

State why and explain which type of refractory coeliac disease is more prone to cancers [2]

Answer 19

Type II:
- Type II have a greater than 50 percent chance of the abnormal lymphocytes spreading outside the gut
- Causes: developing enteropathy-associated T-cell lymphoma (EATL)

Question 20

Which type of cancer in the GI tract do coelaic patients suffer a risk of developing? [1]

Answer 20

Small bowel adenocarcinoma

Question 21

Describe two neuorogical complications of coeliac disease [2]

Answer 21

Anti-gluten antibodies created by the immune system of patients with celiac disease in response to gluten are thought to damage nerves

Peripheral neuropathy: Coeliac disease can be associated with peripheral neuropathy, presenting as numbness, tingling, or burning sensations in the extremities.

Gluten ataxia: This rare neurological complication is characterized by gait disturbances, dysarthria, and nystagmus. A gluten-free diet may improve symptoms in some cases.