Week 11 - Case two Flashcards
there is a link between coeliac disease and which other autoimmune conditions
type 1 diabetes and thyroid disease
what are created in patients with coeliac disease
autoantibodies are created in response to eating gluten.
what do these autoantibodies target
the epithelial cells of the small intestine, leading to inflammation
what are the three antibodies related to coeliacs
Anti-tissue transglutaminase antibodies (anti-TTG)
Anti-endomysial antibodies (anti-EMA)
Anti-deamidated gliadin peptide antibodies (anti-DGP)
where does the inflammation affect
the small bowel, particularly the jejenum.
what does coeliac disease cause in the villi
causes atrophy of the intestinal villi, resulting in malabsorption
what certain human leukocyte antigen (HLA) genotypes is coeliac disease associated with
HLA-DQ2
HLA-DQ8
what are the presenting symptoms of coeliac disease
Failure to thrive in young children
Diarrhoea
Bloating
Fatigue
Weight loss
Mouth ulcers
what is dermatitis herpetiformis
is an itchy, blistering skin rash, typically on the abdomen caused by coeliac disease
when does anaemia occur
secondary to malabsorption and deficiency of iron, B12, or folate
what are the neurological symptoms that coeliac disease can present with
Peripheral neuropathy
Cerebellar ataxia
Epilepsy
what must the patient do while being investigated for coeliac disease
must continue to eat gluten.
what are the first line blood tests for coeliac disease
Total immunoglobulin A levels (to exclude IgA deficiency)
Anti-tissue transglutaminase antibodies (anti-TTG)
what is the second line option where there is doubt
Anti-endomysial antibodies (anti-EMA)
TOP TIP TO REMEMBER
Initial anti-TTG and anti-EMA antibody tests are IgA. Some patients have an IgA deficiency. When you test for these antibodies, it is important to test for total immunoglobulin A levels because if the total IgA level is low, the antibody test will be negative, even in a patient with coeliac disease. In this circumstance, you can test for the IgG version of anti-TTG or anti-EMA antibodies.
how is the diagnosis of coeliac disease confirmed
by endoscopy and jejunal biopsy
what are the typical biopsy findings
Crypt hyperplasia
Villous atrophy
what is the management of coeliac disease
A lifelong gluten-free diet should completely resolve the symptoms. Dietician input may be helpful. Relapse will occur upon consuming gluten. Coeliac antibodies may help monitor the disease.
what are the complications of coeliac disease
Nutritional deficiencies
Anaemia
Osteoporosis
Hyposplenism (with immunodeficiency, particularly to encapsulated bacteria such as Streptococcus pneumoniae)
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL)
Non-Hodgkin lymphoma
Small bowel adenocarcinoma
what is IBS caused by
a disturbance of the gut-brain interaction resulting in troublesome abdominal pain and intestinal symptoms.