Coeliac Disease

Question 1

What is coeliac disease?

Answer 1

chronic disease of the digestive tract that interferes with the digestion and absorption of food nutrients, is a gluten-sensitive enteropathy

Question 2

What is the presentation of coeliac disease?

Answer 2

• gastro symptoms (diarrhoea, weight loss, abdominal pain)

- extra-intestinal symptoms (anaemia, oesteoperosis)

Question 3

What are the genes implicated in coeliac disease?

Answer 3

Almost all people (95%) with coeliac disease have either the variant HLA-DQ2 allele or (less commonly) the HLA-DQ8 allele.

Question 4

What is the pathophysiology of coeliac disease?

Answer 4

1. Ingestion of gluten-derived peptides
2. Peptides move into lamina propria
3. Gluten peptides are de-amidated by tissue transglutaminase
4. Presentation of gluten-derived peptide gliadin by the HLA molecules to helper T cells.

Question 5

What investigations would you do?

Answer 5

• Small bowel biopsy

- serological tests for ATT-antibodies

Question 6

What are the positive histological findings?

Answer 6

• Villous atrophy
• Crypt hyperplasia
• Increased number of intra-epithelial lymphocytes

Question 7

What are DDx?

Answer 7

Other bowel conditions such as
• small bowel bacterial overgrowth 
• Crohn’s
• IBS
Other infective/oncological disease such as
• lymphoma
• Giardia
• HIV

Question 8

What is the management of coeliac disease?

Answer 8

he primary management of celiac sprue is dietary. Complete elimination of gluten-containing grain products (including wheat, rye, and barley) is essential to treatment.