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Digestive System Module > Coeliac Disease > Flashcards

Flashcards in Coeliac Disease Deck (17):
1

What is Coeliac disease

Abnormal lining of SI

2

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

3

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

4

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

5

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

6

Antibodies against enzyme tranglutaminases

Not cytotoxic
Enzyme Transglutaminases AB are a by-product of inflammation and damage

7

Childhood Coeliac

1. Failure to thrive
2. Diarrohea, irritable, poor appetite
3. May: Iron deficiency
4. May: Short and Abdominal distention
part of Family screening

8

Adult Coeliac

(presumably silent in childhood)
1. Abdominal bloating and discomfort
-50% coeliacs abdominal symptoms
2. Iron deficiency (w. or w/o anaemia)
3. Folate deficiency = high likelihood is coeliac
4. Relative screening
-1:10 first degree rel. 1:35 second degree rel.
-25% coeliacs identified due to relative screening

9

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%)

10

Official Coeliac diagnosis

1. Blood test initially
2. Test family for HLA DQ 8 and 2
3. Antibody test
-if +ve 4. Confirm via Gastroscopy and Duodenal biopsy

11

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

12

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)

13

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)

14

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

15

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

16

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

17

Vitamin D and Gluten free diet

Vitamin D levels need to be check sometimes
if there is problem with vitamin d Absorption