Coeliac Disease Flashcards
(17 cards)
What is Coeliac disease
Abnormal lining of SI
Previous Diagnosis of Coeliac disease
Severe weight loss Multiple nutrient absorption problems 1. Small Intestine Biopsy 2. Gastroscopy- Duodenal Biopsy \+ Blood tests: a) Previously: glaidin antibodies (high false +ve and -ve tests) b) Now: Tissue Transglutaminase Ab, TTG - more accurate antibody tests
Coeliac Iceburg Analogy
Overt severe disease on top
- Majority= Mild or silent disease = below sea level
- Symptomatic –> Silent –> Latent
- symptomatic + silent = Mucosal lesion
- latent= normal mucosa
- All Genetic susceptibility Positive serology: DQ8 and DQ2
- alot more people now w. mild coeliac disease
Coeliac Genetic component
1:10 incidence if 1st degree relative
-2x susceptibility genes: DQ 8 and 2
Common in Northern Europe
w/o DQ2= cannot develop coeliac = Jap and Chinese
Pathogenesis, Pathology and Pathophysiology of Coeliac disease
Pathogenesis: Gluten exposure-abnormal cell and hormone response = causes mucosal damage
Pathology: villus atrophy. crypt hypertrophy. intraepithelial lymphocytes.
Pathophysiology =1. loss of brush border enzymes. 2. Loss of stimulus for pancreatic and bile secretion
Antibodies against enzyme tranglutaminases
Not cytotoxic
Enzyme Transglutaminases AB are a by-product of inflammation and damage
Childhood Coeliac
- Failure to thrive
- Diarrohea, irritable, poor appetite
- May: Iron deficiency
- May: Short and Abdominal distention
part of Family screening
Adult Coeliac
(presumably silent in childhood)
- Abdominal bloating and discomfort
- 50% coeliacs abdominal symptoms - Iron deficiency (w. or w/o anaemia)
- Folate deficiency = high likelihood is coeliac
- Relative screening
- 1:10 first degree rel. 1:35 second degree rel.
- 25% coeliacs identified due to relative screening
Request for Coeliac antibodies
Unexpected Iron deficiency Folate/B12 deficiency Fatigue IBS w. prominant bloating Osteoporosis (early onset/severe) Type 1 Diabetes (insulin 4% +ve) Autoimmune Thyroid disease (5%)
Official Coeliac diagnosis
- Blood test initially
- Test family for HLA DQ 8 and 2
- Antibody test
- if +ve 4. Confirm via Gastroscopy and Duodenal biopsy
Is Gluten free diet sufficient evidence for Coeliac Disease
No Other conditions (such as IBS) can also benefit from/decrease symptoms due to removal of bread
Coeliac Disease Treatment
gluten free diet = ONLY treatment
- Rapid improvement of symptoms
- symptoms may continue to improve for 6-12 months
- Adherence is easier if clear correlation b/w gluten exposure & Abdominal symptoms. (some people do not have clear relationship so inadvertently consume gluten without worry)
- Gluten free is now more commercially available
- Dietary supplements not usually required, except in first 6-12 months if have severe nutrient deficiencies (can promptly replace vit D if required)
Coeliac Intolerance to protein fractions
Wheat: glaidin
Rye: secalins
Barley: hordein
-known due to plant taxonomy
-these grains are really similar- due to a/acid sequence which is involved in initiating the immune process
-corn and rice harmless. oats debatable (but are a good source of fibre)
-quinoa/buckwheat, amaranth, millet (safe accor. to plant taxonomy) + now more widely available
-meat/fish/vege/fruit natural sources okay (apart from cereals)
Processed items ? due to contamination
Wheat starch (in processed food) Distilled Alcohol (from wheat, barley, rye) Distilled White Vinegar Malt + Malt extract -if in doubt leave out
Fibre and Gluten free diet
Sufficient fibre can be problem in gluten free diet
-Constipation pot. problem
High fibre cereal alternatives recommended
+ Good fruit/vege intake
Osteoporosis and Gluten Free diet
Osteoporosis improves significantly with gluten free diet
- Encourage High Calcium diet as well to help further
- Calcium supplementation (required) sometimes in some cases
Vitamin D and Gluten free diet
Vitamin D levels need to be check sometimes
if there is problem with vitamin d Absorption
