Coeliac disease Flashcards
What is the pathophysiology of coeliac disease?
enteropathy in which gliadin fraction of gluten and other related prolamines in wheat, barley, and rye provoke a damaging immunological response in the proximal small intestinal mucosa
Which part of the gut is affected by coeliac disease?
proximal small intestine
What happens histologically in coeliac disease?
Villous atrophy, crypt hyperplasia, increased epithelial lymphocytes:
rate of migration of absorptive cells moving up the villi (enterocytes) from crypts is increased but insufficient to compensate for increased cell loss from villous tips. villi become progressively shorter then absent, leaving flat mucosa
What proportion of the population suffers from coeliac disease?
1%
What can influence the age of chlidhood coeliac disease diagnosis?
age of introduction of gluten into the diet
What is the classical age for young children to present with coeliac disease?
8-24 months of age
What are 6 classical features of coeliac disease presenting in childhood?
- Profound malabsorptive syndrome
- Faltering growth
- Abdominal distension
- Buttock wasting
- Abnormal stools
- General irritability
How common now is presentation of coeliac disease in early childhood?
Now less common, more likely to present less acutely in later childhood
What less specific, ‘non-classical’ features of coeliac disease may also be seen?
- mild, non-specific gastrointestinal symptoms
- anaemia (iron and/or folate deficiency)
- growth faltering
What are 4 groups of children that should be screened for coeliac disease?
- Type 1 diabetes mellitus
- Autoimmune thyroid disease
- Down syndrome
- First-degree relatives of individuals with coeliac disease
What are the key features of malabsorption in the stool?
floating stools that won’t flush, extreme foul odour that pervades whole house
What proportion of school age children are positive for anti-tTG antibody, and are these all symptomatic?
as many as 1 in 100; large proportion not symptomatic
What 2 blood tests can be used to investigate for coeliac disease?
- anti-tTG (immunoglobulin A tissue transglutaminase antibodies)
- EMA (endomysial antibodies)
How effective are serological screening tests for coeliac disease?
highly sensitive and specific
How is a diagnosis of coeliac disease confirmed?
- strongly suggested by positive serology but:
- confirmation depends on demonstration of mucosal changes (increased intraepithelial lymphocytes and variablel degree of villous atrophy and crypt hypertrophy) on small intestinal biopsy performed endoscopically
- followed by resolution of symptoms and catch-up growth upon gluten withdrawal
