Ceoliac Disease

Ceoliac Disease

·        = Gluten sensitive enteropathy: sensitive to gliaden protein fraction in gluten (found in BROW: barley, rye, oats and wheat)

 Epidemiology

·        In Wgtn: prevalence 70 per 100,000, incidence 1.8 per 100,000

·        Male:female = 1:3

·        10% familial recurrence

·        Association with HLA 8

Symptoms

·        Abdominal pain (related to meals), diarrhoea, steatorrhoea, no fever, sudden onset, early satiety, vomiting

·         Symptoms secondary to malabsorption: anaemia (common presentation – Fe absorbed in duodenum), failure to thrive, weight loss, tetany, osteoporosis (¯Ca or Mg), Wernicke‟s encephalopathy

·        Clubbing

Diagnosis

·        Bloods: ferritin, folate, B12, and Ca

·        Faecal fat

·        Contrast Xray

·        Antigliadin IgG antibodies

·        Antigliadin IgA antibodies

·        Endomysial antibodies: high predictive value

·        Diagnosis: histology + histological improvement on gluten-free diet

Differential

·        Other causes of diarrhoea: e.g. Lactose intolerance, IBD, IBS

·        Thyrotoxicosis (® ­bowel motility)

·        ­Ca

Aetiology

·        Dietary factors + environmental agents + genetic pre-disposition (HLA B8, DR3, Celtic ancestry) ® Latent-compensated gluten sensitivity (proximal only, B12 absorbed in terminal ileum) ® Unmasking factors (nutrient deficiency, metabolic stress, infections, etc) ®

 Â·        Symptomatic

Pathology

·        Subtotal villous atrophy

·        Crypt hyperplasia 

·        Leading to abnormal small bowel mucosa and malabsorption. Primarily affects distal duodenum. In severe cases can extend to terminal ileum

Treatment

·        Gluten free diet for life: refer to dietician

·        If severe, prednisone

·        Replenish deficiencies: iron, folate, vitamins 

·        Bones: due to Ca malabsorption – do bone scan, Ca supplements. A diary free diet pre-diagnosis may have improved things as less lactase in coeliac disease 

·        ?Family screening: but antibodies only +ive with mucosal damage (doesn‟t detect latent disease). Keep kids growth charts up to date

·        Refer patients to Ceoliac Society