Coeliac Disease and IBS

Question 1

What is Coeliac Disease?

Answer 1

Autoimmune disease of the GIT
Exposure to gluten results in villous atrophy resulting in malabsorption

Question 2

What are the clinical features of Coeliac Disease?

Answer 2

Diarrhoea
Abdo pain/bloating
Features of malabsorption
Symptoms of anaemia
TATT
Failure to thrive in children

Question 3

What is Coeliac Disease associated with?

Answer 3

HLA- DQ2
Dermatitis Herpetiformis
T1DM

Question 4

What are complications of Coeliac Disease?

Answer 4

Folate/B12/Iron deficiency
Hyposplenism
Osteoporosis

Question 5

What investigations are needed in Coeliac Disease?

Answer 5

1) IgA anti-TTG antibodies
- can do IgA anti-EMA antibodies

Duodenal or jejunal biopsy can be done

Question 6

What is the management of Coeliac Disease?

Answer 6

Gluten free diet
Advised for pneumococcal vaccine every 5 years due to functional hyposplenism

Question 7

How is irritable bowel syndrome diagnosed?

Answer 7

Symptoms present for 6 months

Abdo pain relieved by defecation or with a change in bowel habit
AND at least 2 of the following
-Altered stool passage
-Bloating
-Mucous
-Worse after eating

Must ensure no red flag features present

Question 8

What is the management of IBS?

Answer 8

Abdo pain
1) anti-spasmodics e.g. mebeverine/hyoscine
2) TCA e.g. low dose amitriptyline

Constipation
1) Laxative (not lactulose)
2) Linaclotide if >12 months severe constipation

Diarrhoea
1) Loperamide
Reduce fibre intake/caffeine/carbonated drinks

Low FODMAP diet
CBT- if symptoms do not improve after 12 months of treatmetn