Coeliac disease

• Coeliac disease is an autoimmune condition triggered by eating gluten. It is associated with other autoimmune conditions, especially T1DM and thyroid disorders
• Prolamins are the damaging factor in coeliac disease. They are resistant to digestion by pepsin and chymotrypsin - their presence triggers an immune response that results in coeliac disease
• Endomysial and tissue transglutaminase antibodies are produced and target the epithelial cells in the small intestine, mostly the jejunum
• Inflammatory cascades contribute to the villous atrophy and crypt hyperplasia that are typical of the disease
• Risk factors for coeliac disease:

  • Family history
  • 90% of patients will have HLA-DQA mutation
  • Known autoimmune disease - thyroid disease and T1DM
  • Genetic syndromes e.g. Down's syndrome
• Symptoms of coeliac:

  • Failure to thrive in young children
  • Diarrhoea
  • Bloating
  • Fatigue
  • Weight loss
  • Anaemia - iron, B12 and folate
  • Steatorrhea
• Coeliac disease on exam:

  • Mouth ulcers
  • Angular stomatitis
  • Dermatitis herpetiformis - itchy, blistering skin rash
  • B12 deficiency can cause neurological symptoms such as peripheral neuropathy
  • finger clubbing
  • Muscle wasting
  • Abdominal distension
• Patients must continue to eat gluten before diagnostic tests are performed:

  • Total IgA to exclude deficiency
  • Anti-TTG (lab will do anti-EMA)
  • Genetic HLA DQ2 and DQ8 screen
  • Endoscopy + jejunal biopsy
  • B12 and folate
  • Bone profile - osteoporosis
• Biopsy of coeliac disease will show:

  • Villous atrophy
  • Crypt hyperplasia
• Management of coeliac disease:

  • Life long gluten free diet
  • Replacement of minerals and vitamins
  • Pneumococcal vaccination
  • Annual review - height/weight and nutritional status
• Complications of coeliac disease:

  • Anaemia/nutritional deficiencies - iron, B12 and folate
  • Osteoporosis
  • Hyposplenism - immunodeficiency to encapsulated bacteria
  • Ulcerative jejunitis
  • Malignancies - non-Hodgkin's lymphoma , small bowel adenocarcinoma
• in coeliac disease, gliadin, a component of gluten, is not broken down fully and passes through the intestinal epithelial layer triggering an immune response.
• Extra-intestinal manifestations:

  • Arthritis
  • Dermatitis herpetiformis
  • Osteoporosis
  • Infertility
  • Ataxia
  • Epilepsy
  • Anxiety/depression
• In those with ongoing symptoms, IgA tTG measurements can be carried out to check for compliance with a gluten-free diet