Coeliac Disease – At A Glance

Coeliac disease is a gluten sensitive enteropathy where there is an inability to tolerate gluten containing diet, as an autoimmune reaction will be triggered upon exposure to these gluten proteins destroying the mucous of the intestine leading to malabsorption.

Also called as coeliac spure

Gluten is abundantly found in….

  • Wheat – Bread, pasta, breakfast cereals, cake, etc.
  • Barley – Beer
  • Rye
  • Oats  
 
Incidence : 1 in 3000 individuals 

 
Aetiology And Pathophysiology Of Coeliac Disease
 
It is an autoimmune disease, the exact cause is not properly understood
 
Exposure to gluten
             ↓
Body’s immune system over-reacts to gluten 
             ↓
Trigger immune responses – Produce autoantibodies against type 2 transglutaminase (TG2) 
             ↓
Inflammation of the intestine epithelial surface
             ↓
Damage to intestinal villi leading to a flattened epithelium
             ↓
Malabsorption and its’ consequences 


Risk Factors Of Coeliac Disaese
  • Family history
    • Tends to run in the family
    • Strong association with HLA-DQ2 and HLA-DQ8
  • Rota virus infection during childhood
  • Ulcerative colitis 
  • Down’s syndrome and Turner syndrome
 
 
Conditions Associated With Coeliac Disease
  • Dermatitis herpetiformis
    • Vescicular pruritic skin lesion involving the extensor surfaces of the extremities, trunk, buttocks, scalp, and neck
  • Autoimmune diseases
    • Type 1 diabetes
    • Autoimmune hepatitis
    • Autoimmune thyroiditis 


Clinical Presentation Of Coeliac Disease
  • Intestinal manifestations
    • Diarrhoea 
    • Steatorrhoea
    • Abdominal bloating and flatulence
    • Persistent or unexplained GI symptoms
    • Weight loss
    • Prolonged fatigue 
    • Failure to thrive in children
  • Extraintestinal manifestations
    • Iron deficiency anaemia
      • Due to impaired iron absorption from duodenum
      • Severe cases can affect the absorption of terminal ileum leading to vitamin B12 deficiency 
    • Bleeding diathesis 
      • Due to vitamin K deficiency 
    • Dermatitis herpetiformis
    • Osteopenia and osteoporosis
      • Due to vitamin D deficiency
    • Neurological manifestations
      • Peripheral neuropathy
      • Ataxia 
    • Bipedal oedema
    • Ascites may be present 
    • Postural hypotension
    • Features suggestive of nutritional deficiencies  
 
 
Investigations Of Coeliac Disease
 
Tests should be conducted prior to initiating a gluten-free diet.
  • Antibody test – IgA anti-tissue transglutaminase antibody (IgA TTG)
  • Duodenal biopsy 
    • Shows small intestinal villous atrophy
  • Tests to detect nutritional deficiencies 
    • DEXA scan – To look for osteoporosis
    • Complete blood count and blood picture – To look for anaemia


Treatment Of Coeliac Disease
  • Place the patient in a gluten free diet 
    • Rice 
    • Potatoes
    • Corn (Maize)
    • Soy
    • Dairy products – Cheese, butter and milk
    • Fruit and vegetables 
    • Meat and fish
  • Oats is best avoided
    • Oats can be mixed with other grains during manufacture 
  • Correction of other nutritional deficiencies 
    • Iron
    • Folate 
    • Vitamin B12
    • Vitamin D
  • Corticosteroids are given to patients with refractory coeliac disease 


Complications Of Coeliac Disease
  • Anaemia
    • Iron deficiency anaemia
    • Megaloblastic anaemia
      • Folate deficiency (More commoner than vitamin B12 deficiency)
      • Vitamin B12 deficiency 
  • Hyposlenism 
    • As a complication of chronic folate deficiency
  • Osteoporosis
  • Lactose intolerance
  • Enteropathy associated T cell lymphoma
  • Subertility
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