Gastrointestinal System >
Coeliac Disease

“Chronic inflammatory disease of the small bowel related to gluten ingestion”

Risk Factors
  • Family history (1st degree relatives)
  • Sex (F>M)
Aetiology

T cell response to gluten causes autoimmune damage to small intestinal epithelium → malabsorption and villous atrophy

Pathophysiology
  • Gluten broken down in stomach into gliadin (long-chain aa peptide) → gliadin resistant to protease breakdown → binds IgA → IgA-gliadin complex internalised into enterocytes
  • Modified by TTG → ingested by macrophages and fragments presented via MHC class II (HLA DQ2 or HLA DA8 mutation)
    • CD4 T helper cells bind to antigen presented on MHC and release inflammatory cytokines
    • Inflammatory cytokines (e.g. interferon gamma and TNF) damage epithelial cells and villi in small intestine
    • CD4 cells also stimulate B cells to produce antibodies against gliadin, tTG and endomysial tTG (tTG found in endomysium of muscle fibres)
    • CD4 T helper cells stimulate CD8 killer T cells to kill enterocytes
  • Damaged epithelium causes absorption of more gliadin and increase immune reaction → intestinal damage occurs in duodenum
Clinical Presentation
  • Adults:
    • Chronic diarrhoea,
    • Stetorrhoea
    • Bloating
    • Weight loss
    • Fatigue
    • Anaemia
    • CNS effects e.g. ataxia, seizures
    • Bone problems
    • Ulcers
  • Children:
    • Abdominal distension/bloating,
    • Failure to thrive
    • Diarrhoea
Investigations
  • Gold standard – Endoscopy and duodenal biopsy:
    • Findings show:
  • Antibody blood tests: anti-gliadin, anti-tTG, anti-endomysial
  • FBC: check for anaemia (¯B12, Hb, ferritin), inflammation
Management
  • Gluten Avoidance
Complications
  • Dermititis herpetiformis
  • Small bowel cancer
  • T cell lymphoma

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