Coeliac Disease

Exam Cram

• Coeliac disease is caused by a hypersensitivity reaction to gliadin in gluten

• Presentation: abdominal pain, bowel habit changes, weight loss dermatitis herpetiformis

• Diagnosis: anti-TTG antibodies (normal IgA leveles) and microvilli destruction on jejunal biopsy

• Management: remove gluten

Outline

Background

• Coeliac disease is caused by a hypersensitivity to gliadin in gluten

• IgA immune response to gliadin

• Associated with hyposplenism, hypothyroidism and intestinal pneumoatosis

Assessment

History

• Abdominal pain, diarrhoea, flatus

• Weight loss

Examination

• Itchy papular rash (dermatitis herpetiformis)

Investigations

• Malabsorption: anaemia, low B12, folate, iron

• HLA DQ2 & DQ8

• antiTTG antibodies (normal IgA levels)

• Biopsy: villous atrophy & crpt hyperplasia

Diagnosis

Diagnostic criteria: villous atrophy on biopsy

• IgA deficiency can cause anti-TTG to be falsely normal

Differentials: Irritable Bowel Syndrome , Crohn's Disease, Ulcerative Colitis 

Management

• Gluten free diet

• If hyposplenism: vaccinate pneumonoccocus, meningococcus and influenza

Dermatitis Herpetiformis

Skin reaction as part of coeliac hypersensivitiy. This skin reaction is only found in coeliac disease. 

Presentation

• Erythematous, itchy papules

Management

1. Gluten Free Diet

2. PO Dapsone (risk of blood dyscrasias)

3. PO Sulfapyridine

Med Reg Notes

References and Resources

Produced 2024