Coeliac Flashcards
What is the cause of coeliac and when does it usually develop?
Genetic and enironmental factors
Can develop at any age
What autoimmune conditions are usually linked with coeliac?
Type 1 diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosis cholangitis
What is the pathophysiology of coeliac disease?
Autoantibodies (created in response to gluten) target epithelial cells of the small intestine, leading to inflammation.
These antibodies may dissapear with effective management
What are the antibodies associated with coeliac disease? (HINT: There are 3 of them)
Anti-tissue transglutaminase (anti-TTG)
Anti-endomysial antibodies (anti-EMA)
Anti-deamidated gliadin peptide antibodies (anti-DGP)
These autoantibodies rise and fall in level depending on how active and severe the condition is
Where does coeliac disease affect the body? What are the effects of it?
The jejunum
Causes atrophy of the intestinal villi —> so causes malabsorption of nutrients
How may patients with coeliac present?
Coeliac is often asymptomatic so have a low threshold when testing for coeliac
Failure to thrive in young children
Diarrhoea
Bloating
Fatigue
Weight loss
Mouth ulcers
One thing to remember is patients may also have dermatitis herpetiformis (itchy,listering skin rash usually on the abdomen). This is caused by coeliac disease.
What are the 2 genes associated with coeliac disease?
HLA-DQ2
HLA-DQ8
What vitamins may a patient with coeliac be deficient in?
Iron, folate, B12
What type of antibodies are anti-TTG and anti-EMA?
IgA antibodies
When you test for anti-TTG and anti-EMA antibodies, it is also important to do a TOTAL immunoglobulin A test.
You do this because if you have a low level of IgA in the body, then you would have low anti-TTG and anti-EMA (even if pt has coeliac causing false negative)
How do you start to diagnose somone with coeliac? What must they do for the diagnosis to be correct?
The patient must be on a diet containing gluten
Then you do a total IgA level test (to exclude IgA deficiency)
The check for anti-TTG
Anti-EMA are a second line option where there is doubt (e.g.borderline result)
What happens to patients who have a positive antibody test when investigating for coeliac?
They are reffered to a gastroenterlogist to confirm the diagnosis by endoscopy and jejunal biopsy.
What would you see in a biopsy finding if a patient has coeliac disease?
Crypt hypertrophy
Villous atrophy
What are some complications of coeliac disease if left untreated?
Vitamin deficiency
Anaemia
Ulcerative jejunitis
Osteoporosis
Enteropathy-associated T-cell lymphoma (lymphoma of the intestine)
Non-hodgkin lymphoma
Small bowel adenocarcinoma
What is the treatment for coeliac disease?
Life long gluten free diet.
If someone continues to have gluten despite having coeliac, it can lead to:
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
