Coeliac disease
| Headline | |
|---|---|
| Etiology | T-cell-mediated small bowel inflammation from ↑ sensitivity to gluten. Associations: HLA DQ2/DQ8, PBC, autoimmune. |
| Epidemiology | Onset at any age, but peaks at infancy + 50-60y. |
| Clinical presentation | - abdo distension, wasted buttocks, ↓ growth, steatorrhea, bloating, dermatitis herpetiformis (RARE; blistering rash on extensor surfaces), mouth ulceration - clubbing, villous atrophy, anaemia, IgA deficiency |
| Pathogenesis | |
| Diagnostic investigations | IgA anti-tTG (-ve after gluten-free diet)/anti-endomysial. FBC: Hb ↓, ferritin ↓, B12 ↓ Endoscopy: villous atrophy, crypt hyperplasia, scalloping of mucosa – reversible on gluten-free diet. |
| Management | Gluten-free diet ± Vit D supp. Exclude coeliac in anyone with "irritable bowel syndrome"! Coeliac crisis: longstanding untreated coeliac disease = shock, ↓ Ca, ↓ albumin. Treatment is supportive. |