Coeliac disease

• T cell mediated autoimmune disease of the small bowel in which prolamine (alcohol soluble proteins in wheat, barley, rye and oats) intolerance causes villous atrophy and malabsorption
• Associated with HLA-DQ2
• Associated with other autoimmune diseases and dermatitis herpetiformis

Presentation

• Steatorrhoea
• Abdo pain
• Bloating
• Nausea/vomiting
• Apthous ulcers
• Angular stomatitis
• Weight loss
• Fatigue/weakness
• Iron deficiency anaemia
• Osteomalacia
• FTT

Diagnosis

• Antibodies – ?-gliadin, transglutaminase and anti-endomysial (an IgA antibody which is 95% specific unless the patient is IgA deficienct)
• Duodenal biopsy – subtotal villous atrophy and crypt hyperplasia

Treatment

• Lifelong gluten free diet

Complications

• Anaemia
• Secondary lactose intolerance
• GI- T cell lymphoma
• Increased risk of malignancy – gastric, oesophageal, bladder, breast, brain
• Myopathies
• Neuropathies
• Hyposplenism
• Osteoporosis