Coeliac Disease Flashcards
Define coeliac disease
Autoimmune gluten sensitive enteropathy causing chronic malabsorption
Triggered by gliadin peptides in gluten in grains such as wheat, barley and rye
What are the causes/risk factors of coeliac disease?
- Family history of coeliac disease
- IgA deficiency
- T1DM
- Autoimmune thyroid disease
What are the symptoms of coeliac disease?
• Asymptomatic • Abdominal pain/discomfort/cramping • Abdominal distension/bloating • Steatorrhea (pale, bulky stool with offensive smell; difficult to flush) • Diarrhoea (chronic or intermittent) • Fatigue • Malaise • Weight loss • Failure to thrive in children • Amenorrhea in young women
What are the sign’s of coeliac disease?
Signs of anaemia
• Conjunctival pallor
Signs of malnutrition
• Short stature
• Abdominal distension
Signs of vitamin/mineral deficiencies
• Osteomalacia (vit D)
• Easy bruising (vit K)
• Aphthous ulcers
Other
• Dermatitis herpetiformis (intense
itchy papulovesicular rash on
elbows, knees, buttocks)
What investigations are carried out for coeliac disease?
Bloods
• FBC - low Hb, iron and folate, low albumin, low Ca2+ and high PO43-
• Iron deficiency anaemia (microcytosis), folate deficiency (macrocytosis)
Serology
• IgA tTG antibody
• IgA endomysial antibody
• False negatives occur in IgA deficiency
Stool
• Culture – exclude infection
• Faecal fat test – steatorrhea
D-xylose
• Reduced urinary excretion after an oral xylose load indicates small bowel
malabsorption
Endoscopy and biopsy
• Villous atrophy, crypt hyperplasia and intraepithelial lymphocytes
What is the management for coeliac disease?
- Strict gluten free diet (most coeliacs tolerate oats)
* Calcium, vit D and iron supplementation
What are the complications of coeliac disease?
- Iron, folate, B12 deficiency
- Osteomalacia
- Lymphoma (especially enteropathy associated T-cell lymphoma - EATCL)
- Small bowel and oesophageal cancer
- Ulcerative jejunoileitis
