Coeliac Disease | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

20

Pages:

5
Author:

Mariam A. A.

Coeliac Disease Definition Immune response to wheat ingested gliadins and proteins in rye, oats and barely. Epidemiology Found in 1 in 70 people in Australia 80% of cases are undiagnosed North Europeans have the highest incidence more common in women more common in people with T1DM or other autoimmune disease more common in people with down syndrome more common in infertile and people with irritable bowel syndrome with diarrhoea Most prevalent autoimmune disease in general practice Can happen at any age but average age is 40 Risk Factors/Triggers Genetic HLA DQ 2 and HLA DQ 8 Stress Pregnancy Surgery Infection Impacted Parts Duodenum More common Esp D1 -> duodenal bulb Jejunum Clinical Features variable may be asymptomatic fatigue diarrhoea or steatorrhea weight loss abdominal pain bloating indigestion excessive wright loss -> missed periods joint pain muscle cramps dental enamel defects symptoms from malabsorption: IDA Osteoporosis Micronutrient deficiency -> unexplained iron, folate, or b12 deficiency Primary infertility or recurrent miscarriage Presence of dermatitis herpetiform should raise suspicion Key info Important to differentiate from non-celiac gluten sensitivity/gluten intolerance Small amounts are tolerated and ingestion does not cause long term damage Improvement of symptoms or exacerbation after gluten reintroduction has a very low predictive value for CD and should not be used for diagnosis in the absence of other supportive evidence. Screening Recommended for patients with: Autoimmune diseases such as thyroid disease, IgA deficiency or T1DM Down syndrome or Turner syndrome First degree relative Screening using HLA DQ2 and HLA DQ 8 is not recommended as 50% of the population has them These being positive -> does not mean coeliac disease is present But coeliac disease can be excluded if they are absent Investigations Blood tests Micronutrients, iron, vitamin B12 and folate Coeliac serology Should be performed in patients consuming 8 to 10 grams of gluten per day -> 4 slices of wheat-based bread Cannot be done in patients with gluten free diet Total IgA To exclude coeliac disease associated IgA deficiency -> because it causes false negative results IgA anti-tissue transglutaminase (usually first choice) Most sensitive Anti-deaminated gliadin-IgA Obsolete and not used any more Anti-endomysial-IgA (not anti-gliadin) Most specific Endoscopy Arrange if serology is positive Gold standard Biopsy of the duodenal mucosa Optimal when the patient is consuming gluten 4 to 6 biopsies Diagnosis is confirmed by typical pathology Intra-epithelial lymphocytosis with villous atrophy of the duodenum Some patients may have intact villous architecture with only intraepithelial lymphocytosi s less specific than villous atrophy. Classical findings to remember villous atrophy and crypt hypertrophy Staging Staging Description 0 Normal 1 Increase percentage of intraepithelial lymphocytes (more than 30%) 2 Increased inflammatory cells and crypt cell proliferation with preserved villous architecture Mild villous atrophy 3 Moderate villous atrophy Subtotal to total villous atrophy 4 Total mucosal hypoplasia (i.e. atrophic)