COELIAC

Question 1

Explain the pathophysiology of coeliac disease

Answer 1

Inflammatory condition of the small intestinal mucosa that is triggered by the ingestion of dietary gluten
- villous atrophy in the lining of the small intestine flatten due to gluten - reduce capacity to absorb nutrients

Question 2

What are the signs and symptoms of coeliac disease

Answer 2

• severe or occasional diarrhoea
• excessive wind or constipation
• perisstent or unexplained nausea and vomiting
• recurrent stomach pain, cramping or bloating
• any combination of Fe, B12 or folic acid deficiency
• anaemia fatigue
• sudden, unexpected weight loss
• faltering growth in children
• mouth ulcers
• skin rash
• tooth enamel problems
• liver abnormalities
• unexpected subfertility
• repeated miscarriages
• neurological problems - ataxia and peripheral neuropathy, tingling hands and feet

Question 3

What is a MARSH classification?

Answer 3

Classifies intestinal lining damage in coeliac - scale of 0 to 4
0 - intestinal lining is normal, CD unlikely
1 - increased number of lymphocytes is seen but normal villi
2 - increased number of lymphocytes, the depressions in the intestinal lining are deeper than normal but normal villi length
3 - villi are becoming flattened
4 - villi are completely flattened

Question 4

Who should be offered serological testing for coeliac disease?

Answer 4

Those suffering from
- type 1 diabetes
- autoimmune thyroid disease
- IBS
- persistent unexplained abdominal / GI symptoms
- faltering growth
- prolonged fatigue
- unexplained wight loss
- mouth ulcers
- unexplained iron, B12 aor folate deficiency
- 1st degree relatives of people with coeliac

Question 5

What advice needs to be given to a patient undergoing tests for coeliac disease?

Answer 5

• explain tests are accurate only if a gluten containing diet is eaten during the diagnostic process
• advise person not to start GF diet
• eat at least some gluten in 1 meal every day for at least 6 weeks before testing

Question 6

What are the micronutrients of concern in someone with coeliac disease?

Answer 6

Calcium and vitamin D - low bone mineral density is common
Folic acid - 5mg/day is recommended for women
Iron
Zinc
Magnesium
Vitamin B6
Vitamin B12

Question 7

Explain how you would monitor a patient with coeliac disease.

Answer 7

Offer annual review
- measure weight, evaluate weight history and BMI
- review symptoms
- consider need for assessment of diet
- consider need for referral
- assess need for other blood tests or long term complications

Question 8

Consequences and conditions associated with coeliac disease

Answer 8

• osteopenia - low bone mineral density
• osteoporosis - due to decreased calcium absorption
• more common in people with autoimmune diseases
• long term undiagnosed - increased risk of developing small bowel cancer and intestinal lympoma