Coeliac disease

Question 1

define coeliac disease?

Answer 1

An autoimmune condition caused by intolerance to GLUTEN, causing chronic intestinal malabsorption

Question 2

what is the aetiology of coeliac disease?

Answer 2

•Due to sensitivity to the GLIADIN component of gluten

Question 3

risk factors of coeliac disease?

Answer 3

• HLA-B8, HLA-DR3 and HLA-DQW2
• • Associations with dermatitis herpetiformis
  • Associations with IBS
  • Associations with T1DM
  • 10% risk of first-degree relatives being affected

Question 4

epidemiology of coeliac disease?•

Answer 4

• UK: 1/2000
• West Ireland: 1/300
• Rare in East-Asia

Question 5

what are the presenting symptoms of coeliac disease?

Answer 5

• May be asymptomatic
• Abdominal discomfort, pain and distention
• Steatorrhoea (pale bulky stool, with offensive smell and difficult to flush away)
• Diarrhoea
• Constant fatigue
• Sudden weight loss
• Failure to ‘thrive’ in children
• Amenorrhoea in young adults
• Unexplained anaemia
• Unexplained nausea and vomiting

Question 6

signs of coeliac disease?

Answer 6

• Signs of anaemia
• Signs of malnutrition:
• Signs of vitamin/mineral deficiencies
• Signs of dermatitis herpetiformis

Question 7

gold standard investigations for coeliac disease?

Answer 7

•	Serology – gold standard 
o	IgA and TTG antibodies (IgA) are first choice according to NICE 
o	Endomyseal antibody (IgA) 
o	Anti-gliadin antibody (IgA or IgG) 
o	Anti-casein antibodies

Question 8

what might the FBC present for coeliac disease?

Answer 8

o FBC (low Hb, iron and folate)

Question 9

what will endoscopy show?

Answer 9

o	villous atrophy 
o	crypt hyperplasia 
o	flat mucosa 
o	raised intra-epithelial lymphocytes 
o	lamina propria infiltration with lymphocytes

Question 10

what other tests might be undertaken?

Answer 10

• stool

- D-xylose test

Question 11

what advice is given to coeliac disease?

Answer 11

avoid gluten (wheat, rye and barley and oat products)

Question 12

what medical treatment for coeliac disease?

Answer 12

• vitamin and mineral supplements
• Oral corticosteroids if disease does not subside with avoidance of gluten
• Pneumococcal vaccine due to hyposplenism (risk of pneumococcal sepsis)

Question 13

what are the complications of coeliac disease?

Answer 13

• GI lymphoma (particularly T cell) (FLAWS)
• Iron, folate and B12 deficiency (although folate is more common than B12)
• Osteomalacia/porosis
• hyposplenism
• Subfertility
• Lactose intolerance

Question 14

what is the prognosis for patients with coeliac disease?

Answer 14

• FULL RECOVERY
• Symptoms usually resolve within week
• Gluten-free diet must be followed for life