Coeliac disease

Question 1

Pathology

Answer 1

• Gluten broken down into Gliadin in the SI
• Gliadin cannot be broken down further- as a result it cannot be absorbed
• Gliadin binds to transferrin
• This complex is transported across the basolateral membrane and a segment is broken off by tissue transglutaminase
• This new complex triggers an immune response - Triggers the production of anti-transglutaminase IgA antibodies- lead to villous atrophy and inflammation

Question 2

Symptoms

Answer 2

• Abdominal pain
• Malabsorption
• Failure to thrive
• Distended abdomen
• Dermatitis herpatiformis (red, blistering patchiness of the skin)

Question 3

Associated symptoms

Answer 3

• Insulin dependent diabetes mellitus
• Downs
• Malabsorption
• Autoimmune thyroid
• Dermatitis hepatiformis

Question 4

Investigation

Answer 4

-Distal duodenum biopsy: indication of villous atrophy
-FBC: iron deficiency is the most common presentation in adults
-Blood test:
anti-transglutaminase IgA antibodies
WBC
Anti endomysial IgE antibodies
Antigliadin in children
IgA
IgG
-HLA genetic test: 30% of non coeliacs will be positive so only used as a last resort

Question 5

Treatment

Answer 5

Remove gluten

Question 6

Complications

Answer 6

Refractory coeliac disease
Carcinomas :
-small bowel lymphoma 
-Oesophageal carcinoma 
-Colon cancer 
-Small bowel adenocarcinoma

Question 7

what is refractory coeliac disease?

Answer 7

Continuos malapsorption and villous atrophy despite gluten-free diet