Malabsorption /Coeliac CPC

Question 1

What are the genetic loci associated with coeliac disease?

Answer 1

Major predispositions (but also some others)

HLA DQ2 90%
HLA DQ8

(many affect T-cells)

Question 2

Recall the pathophysiology of coeliacs disease

Answer 2

Consumption of food containing gluten → tissue transglutaminase is released → modifies gliadin from gluten proteins → pathogenic T cells react to and are activated by modified gliadin → mediate chronic intestinal inflammation → epithelial damage resulting in villous atrophy, crypt hyperplasia, and loss of brush border → impaired resorption of nutrients in the small intestine (especially in the distal duodenum and proximal jejunum) → malabsorption symptoms

Question 3

What antibodies are usually tested for diagnosis of Coeliacs?

Answer 3

used to be anti-gliadin

Now: antibodies positive until several months after stop eating gluten
* IgA anti-TTG (90-94% sensitive) check igA levels)
* Iga anti-endomysial antibody (85-94%)

Question 4

What is a normal villous: crypt ratio in an duodenal biopsy?

What is a normal lymphocyte level?

Answer 4

villlous:crypt ration is normal 3-5

abnromal if >20 intra-epithelial lymphocytes per epithelial cells

Question 5

What histological changes can be seen in

Answer 5

Villous atrophy + crypt hyperplasia
Increased intra-epithelial lymphocytes

dietary history+ exclude other disease with can mimic coeliac disease

Question 6

What are the complications of coeliac disease?

Answer 6

Malabsorption
Osteomalacia and osteoporosis
Neurological disease
* Epilepsy
* Cerebral calcification
Lymphoma
Hyposplenism

Question 7

What are the extra-intestinal disease associated with coeliacs?

Answer 7

• dermatitis herpetiformis
• Type 1 DM
• Autoimmune thyroid disease
• Down’s syndrome