COELIAC DISEASE

Question 1

3 MAIN SOURCES OF GLUTEN?

Answer 1

BARLEY, RYE AND WHEAT

Question 2

TYPICAL SYMPTOMS OF COELIAC DISEASE?

Answer 2

DIARRHOEA, STOMACH PAIN, BLOATING, FARTING, INDIGESTION, CONSTIPATION
+ FATIGUE, UNINTENTIONAL WEIGHT LOSS, ITCHY RASH, INFERTILITY, PERIPHERAL NEUROPATHY, ATAXIA…

Question 3

WHAT IS THE NAME OF THE ITCHY RASH THAT SOMETIMES ACCOMPANIES COELIAC DISEASE?

Answer 3

DERMATITIS HERPETIFORMIS

Question 4

SHOULD ASYMPTOMATIC COELIAC DISEASE BE TREATED? WHY?

Answer 4

YES, BECAUSE EVEN IF THERE ARE NO SYMPTOMS THE COMPLICATIONS ARISING FROM DAMAGE TO INTESTINAL VILLI CAN STILL OCCUR (E.G. MALABSOPRTION)

Question 5

WHAT IS THE MOST COMMON SYMPTOM OF COELIAC DISEASE?

Answer 5

DIARRHEA

Question 6

STEATORRHEA?

Answer 6

STOOL CONTAINING ABNORMALLY HIGH AMOUNTS OF FAT; FOUL SMELLING, GREASY, DIFFICULT TO FLUSH

Question 7

1 IN HOW MANY COELIAC PATIENTS HAVE DERMATITIS HERPETIFORMIS?

Answer 7

1/5

Question 8

HOW IS COELIAC DISEASE DIFFERENT THAN OTHER AUTOIMMUNE DISEASES?

Answer 8

THE BODY ATTACKS ITSELF BUT IN RESPONSE TO GLIADIN INSIDE GLUTEN, WHILE MOST OTHER AUTOIMMUNE DISEASES LEAD TO BODY ATTACKING ITS OWN TISSUE WITHOUT OUT AN EXTERNAL STIMULANT

Question 9

APART FROM BARLEY, RYE AND WHEAT WHAT ELSE CAN BE HARMFUL FOR PEOPLE WITH COELIAC DISEASE IN MORE SEVERE CASES AND WHY?

Answer 9

OATS, BECAUSE THEY CONTAIN A PROTEIN AVENIN WHICH IS SIMILAR TO GLUTEN

Question 10

RISK OF COELIAC DISEASE IF YOU HAVE FAMILY HISTORY OF IT?

Answer 10

10%

Question 11

IF YOU HAVE AN IDENTICAL TWIN WITH COELIAC, CHANCES YOU WILL DEVELOP IT ARE:

Answer 11

75%

Question 12

MUTATIONS IN WHICH GENE ARE ASSOCIATED WITH COELIAC DISEASE?

Answer 12

HLA-DQ

Question 13

HOW MANY PEOPLE IN THE GEN POP HAVE HLA-DQ GENE MUTATIONS?

Answer 13

1/3

Question 14

ENVIRONMENTAL FACTORS IN EARLY CHILDHOOD THAT CAN INCREASE THE LIKELIHOOD OF DEVELOPING COELIAC:

Answer 14

• HAVING DIGESTIVE SYSTEM INFECTION (E.G. ROTAVIRUS)
• HAVING GLUTEN INTRODUCED TO DIET BEFORE TURNING 3 M.O.
• NOT BEING BREASTFED WHEN GLUTEN IS INTRODUCED IN DIET

Question 15

HEALTH CONDITION THAT CAN INCREASE RISK OF DEVELOPING COELIAC (COMMON COMORBIDITIES):

Answer 15

T1D, THYROID CONDITIONS, ULCERATIVE COLITIS, NEUROLOGICAL DISORDERS LIKE EPILEPSY, DOWN’S, TURNER’S

Question 16

AFTER PATIENTS WITH COELIAC SWITCH TO NO-GLUTEN DIET, IT CAN TAKE UP TO HOW LONG FOR THEIR GI TRACT TO HEAL?

Answer 16

2 YRS

Question 17

IS GLUTEN ESSENTIAL IN DIET?

Answer 17

NO

Question 18

IF A PERSON KEEPS EATING GLUTEN AFTER BEING DIAGNOSED WITH COELIAC, WHAT ARE SOME OF THE LONG TERM RISKS?

Answer 18

VERY UNPLEASANT INTESTINAL SYMPTOMS, CANCER, OSTEOPOROSIS, IRON DEFICIENCY ANEMIA, B12 ANEMIA…

Question 19

MAX AMOUNT OF GLUTEN THAT FOOD LABELLED AS ‘GLUTEN FREE’ CAN CONTAIN:

Answer 19

20 PARTS PER MILLION (PPM)

Question 20

GLUTEN SHOULDN’T BE GIVEN TO BABIES BEFORE THEY TURN:

Answer 20

6 MONTHS

Question 21

GLUTEN CONTENT OF BREAST AND INFANT FORMULA MILK?

Answer 21

ALL ARE GLUTEN FREE

Question 22

WHAT IS REFRACTORY COELIAC DISEASE?

Answer 22

RARE TYPE OF COELIAC WHERE THE SYMPTOMS PERSIST EVEN IF ONE’S DIET IS COMPLETELY GLUTEN FREE, REASONS ARE UNKNOWN

Question 23

HOW MANY PEOPLE WITH COELIAC HAVE THE REFRACTORY TYPE OF THE DISEASE?

Answer 23

1/140

Question 24

HOW MANY PEOPLE IN THE UK ARE AFFECTED BY COELIAC?

Answer 24

1%

Question 25

WHICH SEX IS AFFECTED BY COELIAC MORE AND HOW MUCH MORE?

Answer 25

WOMEN, 3 TIMES MORE THAN MEN

Question 26

MOST COMMON AGES OF DIGANOSIS OF COELIAC DISEASE:

Answer 26

``` EARLY CHILDHOOD (BEFORE 1 Y.O.) OR LATE ADULTHOOD (40-60!!!) ```

Question 27

WHAT PERCENTAGE OF PEOPLE WITH COELIAC ARE SENSITIVE TO OATS AS WELL?

Answer 27

5%

Question 28

TESTING FOR WHICH ANTIBODIES IS A VERY SENSITIVE AND SPECIFIC TESTS FOR DIAGNOSIS OF COELIAC?

Answer 28

ANTI-tTG (TISSUE TRANSGLUTAMINASE)

Question 29

WHAT STIMULATES IMMUNE RESPONSE BY T LYMPHOCYTES IN COELIAC DISEASE?

Answer 29

TISSUE TRANSGLUTAMINASE (tTG) INSIDE OF ENTERIC CELLS DEAMIDATES GLUTAMINE IN GLIADIN, CONVERTING IT FRO A NEUTRAL TO A NEGATIVELY CHARGED MOLECULE, WHICH WILL STIMULATE THE T CELLS.

Question 29

WHAT STIMULATES IMMUNE RESPONSE BY T LYMPHOCYTES IN COELIAC DISEASE?

Answer 29

TISSUE TRANSGLUTAMINASE (tTG) INSIDE OF ENTERIC CELLS DEAMIDATES GLUTAMINE IN GLIADIN, CONVERTING IT FRO A NEUTRAL TO A NEGATIVELY CHARGED MOLECULE, WHICH WILL STIMULATE THE T CELLS.

Question 30

WHICH ANTIBODIES WILL USUALLY BE PRESENT IN PEOPLE WITH COELIAC WHEN THEY CONSUME GLUTEN?

Answer 30

ANTIGLIADIN ANTIBODIES, ANTI-tTG ANTIBODIES AND IgA ANTIBODIES TO SMOOTH MUSCLE ENDOMYSIUM

Question 31

WHAT ARE SOME OF THE COMMON SUPPLEMENTATIONS THAT MIGHT BE REQUIRED FOR PATIENTS WITH COELIAC AFTER SWITCHING TO GF DIET?

Answer 31

B12, FOLATE, VIT D, IRON, ZINC, CALCIUM, Mg

Question 32

HOW DOES THE NEED FOR CALCIUM IN PEOPLE WITH COELIAC COMPARE TO THAT OF PEOPLE WITHOUT COELIAC?

Answer 32

PEOPLE WITH COELIAC HAVE HIGHER REQUIREMENTS FOR CALCIUM (1000 mg per day compared to 700 in gen pop)

Question 33

WHAT IS ONE OF THE FIRST CHANGES IN THE INTESTINE IN PEOPLE WITH COELIAC?

Answer 33

INCREASED NUMBER OF INTRAEPITHELIAL LYMPHOCYTES

Question 34

WHAT PERCENTAGE OF PEOPLE WHO MEET DIAGNOSTIC CRITERIA FOR IBS DON'T HAVE A FORMAL DIAGNOSIS?

Answer 34

CCA 40%

Question 35

WHAT IS THE PERCENTAGE OF PEOPLE WITH IBS (PREVALENCE INTERNATIONALLY)?

Answer 35

10-15%

Question 36

DOMINANT POPULATION WITH IBS IN TERMS OF SEX AND AGE?

Answer 36

WOMEN | YOUNGER THAN 50 Y.O.

Question 37

HOW IS IBS DEFINED ACCORDING TO THE ROME IV CRITERIA?

Answer 37

RECURRENT ABDOMINAL PAIN AT LEAST ONE DAY A WEEK IN THE LAST 3 MONTHS ASSOCIATED WITH AT LEAST TWO OF THE FOLLOWING: - RELATED TO DEFECATION - ASSOCIATED WITH CHANGE IN STOOL FREQUENCY - ASSOCIATED WITH CHANGE IN STOOL FORM/APPEREANCE

Question 38

MANAGEMENT STRATEGIES FOR IBS:

Answer 38

- EXCLUSION OF GAS PRODUCING FOODS - LOW FODMAP DIET - GLUTEN AND LACTOSE AVOIDANCE IN SOME CASES - AVOIDANCE OF LARGE MEALS - REGULAR MEAL PATTERN - REDUCED INTAKE OF FAT, INSOLUBLE FIBRES, CAFFEINE