Coeliac disease

Coeliac disease

• Hypersensitivity to gliadin in wheat, barley, rye
• Small intestinal disease

Epidemiology

• England 1:300; Ireland 1:100
• Caucasians mainly
• Positive family history

Pathology

• Subtotal villous atrophy
• Loss of villi
• Crypt hyperplasia
• Malabsorption

Clinical features

• Abdominal pain
• Diarrhoea
• Steatorrhoea/malabsorption
• Weight loss
• Symptoms of anaemia
• Mouth ulceration
• Anaemia
• Pale conjunctivae (50% iron deficiency)
• Dermatitis herpetiformis (blistering rash on extensor surfaces)

Investigations

• Anti-endomysial antibodies
• Negative after gluten-free diet
• Tissue transglutaminase
• Negative after gluten-free diet
• Antigliadin antibodies
• Antireticulin antibodies
• Endoscopy and duodenal biopsy
• Full blood count
• Anaemia (macrocytic or microcytic)
• Hyposplenism, Howell-Jolly bodies

Disease associations

• Thyroid disease/diabetes
• Primary biliary cirrhosis
• Autoimmune hepatitis

Complications

• Ulcerative jejunitis
• Small bowel lymphoma
• Oesophageal carcinoma
• Osteomalacia

Management

• Gluten-free diet
• Iron/folate supplementation