Coeliac Disease
A+E
Idiopathic / Genetic / Cereal glutens. 1% population
P+P
Gluten protein(WORB):
Pathology:
Genetics:
Complications:
Wheat (Gliandin),Oats, Rye (Secalins) + Barley (Hordeins)
Villous atrophy + crypt hypoplasia
70% MZ twin concordance, 15% 1st gen relative. HLA DQ2 + DQ8
Dermatitis Herpetiformis, atopy + AI disease, IgA deficiency, osteoporosis (even on diet),
Oesophageal + other GI Ca
S+S
Asymptomatic:
Steatorrhoea:
Abdo Pain:
Weight loss:
Mouth Ulcers:
Neurological S+S:
Wasted Buttocks:
DH:
Thought to be present in a larger proportion of the population than previously thought
Pale, malodorous floating stools
+ Bloating
+ angular stomatitis  + intermittent
Paraesthesia, ataxia (cerebellar calcification), muscle weakness, polyneuropathy, tetany
Paediatric cases
Dermatitis Herpetiformis Small, itchy blisters over elbow, extensor forearms, scalp + buttocks
DDx
Steatorrhoea:
Pancreatic Ca, Pancreatitis, PSC, bacterial overgrowth, short bowel syn, Zollinger Ellison, CF,
giardiasis, drugs (Orlistat etc.), HyperT, gallstones
Blisters(PINCHED ITS): Pemphigus, Pemphigoid, porphyria, pellagra, IgA dermatosis, Necrotizing fasciitis, Chickenpox
Herpes, HF+M, Epidermolysis bullosa, dermatitis herpetiformis, Impetigo, Trauma, SJS
Iф (Need 2W normal diet before IO)
Hx:
FBC:
Blood Film:
Small Bowel Biopsy:
Ab:
Small bowel follow:
DEXA scan:
WAND PUBS TIMI + WOLF CAST BOMBS + IBDIFMAG
Normocytic Anaemia(50%) due to folate + B12 deficiency + IDA (so ↑ RDW)
Microcytes + Macrocytes. Hypersegmentd NO + Howell Jolly bodies due to splenic atrophy
4 – 6 forceps biopsy from 2nd part of duodenum for histology
Mucosal fold absence, mosaic pattern + scalloping of mucosal folds
Villous atrophy, crypt hyperplasia + inflammatory cell infiltrates in lamina propria
①Endomysial Ab + ②Tissue Trans Glutaminase Ab (TTG)( Can monitor dietary efficiency)
Small bowel dilatation with slow dilatation
For absorptiometry
Tx
Nutrients:
Gluten Free Diet:
Pneumo vaccination:
Replace + continue to build
life, may take M to improve. No WORB. Can eat potatoes, rice + maize
Every 5Y due to hyposplenism
TxSE
Gluten free diet:
Failure to comply