Coeliac Disease

Inflammatory condition induced by the ingestion of gluten (protein found in wheat, barley and rye)

Aetiology

  • Genetically linked auto-immune disorder
    • Genetic susceptibility + trigger (trigger currently unknown, possibly enteric virus)
    • HLADQ2/HLADQ8 gene - code for type II MHC molecules
  • Average age of diagnosis - 40-60 years

Pathophysiology

  • Not an allergy - T cell/IEL mediated
  • Activated T cells and IELs kill epithelial cells
  • Causes damage to small intestine, leading to malnutrition
  • Damage is reversible (usually) - damaged enterocytes are replaced by normal ones when patients stop eating gluten

Clinical presentation

  • 1/3 asymptomatic

Symptoms

  • General malaise/tiredness - often duet iron deficiency anaemia
  • Diarrhoea
  • Nausea and vomiting
  • Bloating
  • Weight loss
  • Oral ulceration

Signs

  • Dermatitis herpetiformis - itchy blisters caused by subepithelial IgA deposition

Investigations

  • Serology (IgA anti-TTG) use to screen who needs a biopsy
  • Biopsy - gold standard
  • Patients need to be consuming gluten for 4-6 weeks before biopsy/serology

Management

  • Lifelong adherence to a gluten free diet

Complications

  • Refractory coeliac disease can progress to T-cell lymphoma