Tuesday, 16 November 2010

MRCP revision battle 51.4: Coeliac's Disease

Coeliac disease is a T cell mediated autoimmune disease of the small bowel.

There is intolerance to prolamins (proteins found in wheat, barley, rye) which results in villous atrophy and malabsorption.

Gliadin (found in gluten) is a form of prolamin.

Presentation may be with:
  • abdominal pain
  • weight loss
  • nausea and vomiting
  • steatorrhoea
  • bloating

Patients must eat gluten for 6 weeks prior to testing.

NICE recommends diagnosis is by tissue transglutaminase (TTG) antibodies (IgA)
Endomysial antibodies and anti gliadin antibodies may also be found but are not recommended by NICE.

Jejenal biopsy may show:
  • villous atrophy
  • crypt hypoplasia
  • raised intraepithelial lymphocytes
  • lamina propria infiltrates with lymphocytes

Associations with coelic disease include:
  • dermatitis herpetiformis
  • type 1 diabetes
  • autoimmune hepatitis

Management is by careful diet.

Now on to some botulism...