Coeliac disease
Coeliac disease
Coeliac disease is an autoimmune disease where the immune system reacts abnormally to gluten.
For people with coeliac disease, even small amounts of gluten can damage the lining of the small intestine (bowel),
which prevents the proper absorption of food nutrients
Clinical features
Diarrhea Fatigue
Weight loss
Diarrhea Fatigue Weight loss
Bloating and gas
Abdominal pain
Constipation
Nausea and vomiting
Joint pain
Dermatitis herpetiformis
Anaemia mouth ulcers
Ataxia
Peripheral neuropathy
Diagnosis
Duodenal biopsy showing villous atrophy IgA anti-endomysial antibodies
IgA. Transglutaminase antibodies—High sensitivity and specificity
Investigation for comorbidity
- bone mineral density (DEXA)
- full blood count
- iron, vitamin B12, folic acid
- thyroid function tests
- Calcium
- Phosphate
- Vitamin D
- PTH
- LFT
Associations
Type 1 Diabetes Pernicious anemia
Primary biliary cirrhosis
Subfertility
Lymphoma
Osteoporosis
Autoimmune thyroid disease Downs syndrome
Management
Gluten-free diet – lifelong elimination of all gluten-containing grains (ie. wheat, rye, triticale, barley) from the diet.
Referral to dietician
Treat specific vitamin/ nutritional deficiencies
Pneumococcal vaccination
Referral to gastroenterologist
First-degree relatives should be screened, and if there are several affected family members second-degree relatives
should also be tested.
Screening for thyroid disease, osteoporosis, and other nutrient deficiencies
Lymphoma surveillance
Causes of non-compliance to a gluten-free diet
- Inadequate education
- Lack of cooking skills
- No dietician referral
- Food not prepared by the patient
- Frequent travel
- Frequent travel • Inability to read food labels due to impaired vision
- Non-English speaking,
- Frequent dining out
- Lack of motivation • Multiple carers
- Lack of assertiveness