Coeliac Disease
Definition
T cell mediated autoimmune disease of small bowel—> gluten intolerance that causes villous atrophy and malabsorption
Epidemiology:
Clinical Features
Symptoms
Steatorrhoea, diarrhoea, abdo pain, bloating, flatulence, N&V, LOW, fatigue, failure to thrive in children
Signs
Generalised abdo pain, abdo distension, apthous ulcers, angular stomatitis, anaemic (Fe and Vit B12 absorbed in duodenum + jejunum), osteomalacia
Investigations
NOTE: Do not start gluten free diet before screening
Complications
Management
Source
OHCM 9th Ed 2014
Harrison's 18th Ed 2012
T cell mediated autoimmune disease of small bowel—> gluten intolerance that causes villous atrophy and malabsorption
Epidemiology:
- Bimodal (young and 50-60s), F slightly > M
- Associated with autoimmune diseases, dermatitis herpetiformis, HLA DQ2, DQ8 etc
- FHx:10% prevalence in 1st degree relative
Clinical Features
Symptoms
Steatorrhoea, diarrhoea, abdo pain, bloating, flatulence, N&V, LOW, fatigue, failure to thrive in children
Signs
Generalised abdo pain, abdo distension, apthous ulcers, angular stomatitis, anaemic (Fe and Vit B12 absorbed in duodenum + jejunum), osteomalacia
Investigations
- Bloods: FBE (Hb -, RCDW +), iron studies (Fe -, ferritin -), Vit B12 -, antibody serology (alpha-gladin, transglutaminase, anti-endomysial)
- Others: Duodenal biopsy (villous atrophy, increased intra-epithelial WBCs, crypt hyperplasia)
NOTE: Do not start gluten free diet before screening
Complications
- anaemia, osteoporosis, myopathies, nueropathies
- increased risk of malignancy - GI T cell lymphoma*, gastric, oesophageal etc)
Management
- Prognosis: intestinal findings + Sx reversible
- Adherence to gluten-free diet
- Avoid contamination, i.e. cooking utensils
- Nutritional supplementation
- Educate school or carers
- Provide handout, refer to dietician, ?specialist and support services like Coeliac AU
Source
OHCM 9th Ed 2014
Harrison's 18th Ed 2012