def
inflammatory disease caused by intolerance to gluten, causing chronic intestinal malabsorption
aetiology
sensitivity to gliadin component of gluten
triggers an immune response in small intesting leading to mucosal damage & loss of villi
what haplotypes show genetic susceptibility for coeliacs disease
HLA-88
DR3
DQW2
epi
1 in 2000 prevalence in UK
more common in ireland
history
may be asymptomatic abdominal pain & distension steatorrhoea or diarrhoea weight loss despite normal diet failure to thrive in children amenorrhoea in young adults
what is steatorrhoea
fat in stool
pale bulky stool
offensive smell
examination
1 signs of anaemia (pallor)
2 signs of malnutrition (short stature, abdominal distension, wasted buttocks in children)
3 signs of vitamin/mineral deficiencies (osteomalacia, easy bruising)
4 dermatitis herpetiformis (itchy blisters on elbows/knees/buttocks)
investigations
1 bloods
-FBC (low Hb)
-microcytic RBCs (low iron)
2 serology
-IgG anti-gliadin (AGA), IgA & IgG anti-endomysial transglutaminase can be diagnostic
3 stool
-culture to exclude infection
4 D-xylose test
-reduced urinary excretion after an oral xylose load indicates small bowel malabsorption
5 endoscopy
-shows villous atrophy especially in the jejunum & ileum, which gives a flat smooth appearance
-biopsy shows villous atrophy with crypt hyperplasia of the duodenum
-epithelium has a cuboidal appearance
management
advice -avoid gluten (wheat, rye, barley) medical -vitamin & mineral supplementation -oral corticosteroids if disease does not subside with gluten withdrawal
complications
iron, folate, vitB12 deficiency
osteomalacia
ulcerative jejunoileitis
GI lymphoma (particularly T cell)
prognosis
complete avoidance of gluten (for life) usually leads to full recovery
symptoms resolve rapidly, histological changes take longer