Coeliac Disease

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Coeliac Disease

• Dr Nader Ghaderi, GPR

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General information

• First described in ancient Greek by Aretaeus of
  Cappadocia
• The word Coeliac was first used in 19th century
  in a translation and was derived from the Greek
  word koiliakos meaning abdominal.
• Many other names Celiac disease, coeliac sprue,
  non-tropical sprue, gluten enteropathy, endemic
  sprue, .

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Coeliac disease

• Autoimmune disorder
• Heightened immunologic response to ingested
  gluten in genetically susceptible people
• More prevalent than previously thought 2.4 in
  Finland, less in the UK and Germany
• Usually GI symptoms
• Other symptoms are increasingly being recognised
• Some patient may have no symptoms
• Often coexists with other conditions

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Pathology

• No signs or symptoms before starting gluten in
  diet
• Inflammatory reaction in small bowel following
  ingestion of gluten, caused by immune reaction to
  modified gliadin( the protein in gluten) by tTGA
• Villous atrophy caused by this autoimmune
  reaction
• Villous atrophy causes malabsorption
• The only effective life-long treatment is
  gluten-free diet

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NICE recommendation

• Offer serological testing to children and adults
  with any of the following signs, symptoms and
  conditions

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Signs and symptoms

• Chronic or intermittent diarrhoea
• Failure to thrive or faltering growth in children
• Persistent or unexplained GI symptoms including
  nausea and vomiting
• Prolonged fatigue ( tired all the time)
• Recurrent abdominal pain, cramping or distension
• Sudden or unexpected weight loss
• Unexplained iron deficiency anaemia or other
  unspecified anaemia

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Conditions

• Autoimmune thyroid disease
• Dermatitis herpetiformis
• IBS
• DM type I

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NICE recommends

• Consider offering serological tests to children
  and adults with any of the following conditions
• Addisons disease
• Amenorrhoea
• Aphtous stomatitis ( mouth ulcers)
• Atuimmune liver conditions
• Autoimmune myocarditis
• Chronic thrombocytopaenic purpura
• Dental enamel defects

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Also

• Depression or bipolar disorder
• Downs syndrome
• Epilepsy
• Low trauma fracture
• Lymphoma
• Metabolic bone disease such as rickets or
  osteomalacia
• Microscopic colitis
• Persistent or unexplained constipation
• Persistent raised liver enzymes with unknown cause

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And

• Polyneuropathy
• Recurrent miscarriage
• Reduced bone mineral density
• Sarcoidosis
• Sjogrens disease
• Turner syndrome
• Unexplained alopecia
• Unexplained subfertility

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Serological tests

• IgA tTGA as first test
• EMA if above test equivocal
• IgA deficiency test if IgA tTGA negative
• If IgA deficient then IgG tTGA
• If serology positive refer to gastroenterologist
  for further investigations and biopsy
• If serology negative and high clinical suspicion
  refer to GI
• If serology negative and low clinical suspicion
  then coeliac disease is unlikely

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Prior to serology or biopsy

• To have an accurate test, patient should be
  taking gluten in diet
• Should eat some gluten in more than one meal
  every day for at least 6 weeks before testing
• They should not start a gluten-free diet until
  the diagnosis is confirmed by biopsy.

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Gluten containing food

• Wheat
• Barley
• Rye
• Wheat subspecies like semolina, spelt, durum,
• Small minority of patients may react to oat,
  likely due to contamination during food
  processing, pure forms are available.

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Gluten free foods

• Maize
• Wild rice
• Non-cereal carbohydrate rich foods like potatoes
  and bananas.
• Processed food available

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Resources

• http//www.coeliac.org.uk/gluten-free-diet-lifesty
  le/food-on-prescription details the monthly
  quantities and types of gluten free foods a GP
  may can prescribe
• Lots of useful information from recipes to advice
  for healthcare professionals http//www.coeliac.or
  g.uk/coeliac-disease
• The review appointment checklist
  http//www.coeliac.org.uk/healthcare-professionals
  /management-of-coeliac-disease/review-appointment-
  checklist