Coeliac disease

Question 1

Coeliac disease

Answer 1

Immunologically mediated disease in genetically susceptible individuals, driven by gluten resulting in chronic inflammation of the small bowel mucosa

Question 2

Clinical presentations

Answer 2

• Diarrhoea, bloating, abdominal cramps, flatulence
• Anaemia, vitamin deficiencies
• Malabsorption of nutrients
• Failure to thrive as an infant
• Osteoporosis
• Lethargy (chronic fatigue), migraines, infertility, mouth ulcers
• Increased prevalence of autoimmune diseases
• Can be completely asymptomatic

Question 3

T-Cells in coeliac disease

Answer 3

CD4+ T cells reactive to gluten-specific epitopes reside in the small bowel mucosa and cause damage by producing harmful cytokines and by accumulating in the epithelium and are involved in the innate immune response

Question 4

Diagnosis

Answer 4

Serological testing
-Tissue transglutaminase antibody
-Deaminated gliadin peptin
Small bowel biopsy during gluten exposure is gold standard for diagnosis

Question 5

Long term risks of untreated coeliac disease

Answer 5

Increased risk for small bowel lymphoma, small bowel adenocarcinoma, oesophageal cancer, increased mortality