Coeliac disease Flashcards
what is coeliac disease
T cell mediated autoimmune disease affecting small bowel
causes gluten intolerance
what are the symptoms of coeliac disease
chronic or intermittent diarrhoea
longstanding or unexplained GI symptoms –> nausea, vomiting, bloating, abdominal pain
prolonged fatigue
sudden or unexpected weight loss
in children –> it causes failure to thrive or poor growth –> indicates severe disease
unexplained iron/folate/B12 anaemia –> causes pallor (B12 deficiency is rare)
severe or persistent apthous mouth ulcers
(if patients have any of the above symptoms then screen them for coeliacs)
they are certain conditions which are associated with coeliac disease, so symptoms for these as well should be noted:
T1DM
Autoimmune thyroid disease
Dermatitis herpetiformis - pruritic papulovesicular lesions over the buttocks and extensor surfaces of the arms, legs, and trunk (sign of severe disease)
patient may also have:
easy bruising –> due to vitamin K deficiency
what are the investigations done in suspected coeliacs disease
brief overview
diagnostic bloods:
serological tests, if positive –> endoscopic intestinal biopsy (gold standard)
basic bloods:
FBC - microcytic anaemia (iron deficiency), normocytic anaemia (anaemia of chronic disease), macrocytic anaemia (folate deficiency)
U&Es and bone profile - vitamin D absorption might be impaired
LFTs - albumin might be low due to malabsorption
Iron, folate, B12 - deficiencies due to malabsorption
who is offered screening for coeliac disease
patients with any of the specific symptoms or with one of the following conditions
explain the diagnostic tests for coeliac’s disease
what are the expected results
serological tests:
IgA tissue transglutaminase antibodies (Anti-TTG IgA) and total IgA
total IgA tests look for selective IgA deficiency –> which would cause a false negative anti-TTG IgA
positive anti-TTG IGA –> referral for biopsy
endomyseal IgA (IgA EMA) can also be used
weakly positive anti-TTG IgA + positive IgA EMA –> referral for biopsy
endoscopic intestinal biopsy:
usually done from duodenum but can be done from jejunum
+ve coeliac features are
villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes
patients must be eating gluten at least 6 weeks before tests are done
what are the complications of coeliac disease
anaemia:
iron deficiency - microcytic
anaemia of chronic disease - normocytic (serum Fe2+ is low but iron stores are normal because ferritin is normal)
folate (or B12) deficiency - macrocytic
**hyposplenism **–> more vulnerable to encapsulated organisms
**osteroporosis **–> DEXA scan showing bone density <2.5 standard deviations
osteomalacia –> caused by vitamin D deficiency
enteropathy associated T cell lymphoma of small intestine –> risk of developing this directly correlates to overall patient adherence to gluten free diet
lactose intolerance
what are the biopsy findings of coeliac disease
endoscopic intestinal biopsy:
usually done from duodenum but can be done from jejunum
+ve coeliac features are
villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes
what is the management of coeliac’s disease
**strict gluten free diet **
patients may need education on what foods contain gluten
gluten = wheat (bread, pasta), barley (beer), oats, rye
(rice, pasta, corn are all gluten free)
immunisation:
coeliacs disease patients might have funcitonal hyposplenism –> all patients should have one-off pneumococcal vaccine
offered flu vaccine
who is at risk of developing coeliacs
2x more common in women than men
irish populations
family history
having HLA-DQ2 allele
having other autoimmune conditions - T1DM, autoimmune thyroid (graves or hashimotos)
when does coeliac’s present
bimodal:
in infancy
aged 50-60
what are the dermatological manifestations of coeliacs
dermatitis herpetiformis:
symmetrical distribution,
itchy papules + clusters of vesicles
on buttocks, trunk and extensor sufarces of arms + legs
more common in men
easy bruising –> vitamin K deficiency
how can you monitor adherence to gluten free diet in coeliac’s disease
measure IgA-TTG
