Coeliac Disease

Answer Explanation:

• Coeliac disease is not caused by an anaphylactic response to gluten, but rather an immune response that damages the lining of the small intestine.
• Anti-mitochondrial antibodies are not a typical feature of coeliac disease. They are more commonly associated with primary biliary cirrhosis.
• A jejunal biopsy in coeliac disease does not show villous hypertrophy. Instead, it shows villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes.
• Steroids are not the mainstay of treatment for coeliac disease. The primary treatment is a lifelong gluten-free diet.
• The correct answer is that there is an association with gastrointestinal malignancies. People with coeliac disease have a higher risk of certain types of cancer, including small bowel cancer and non-Hodgkin lymphoma.

Overview of Coeliac Disease:

• Definition: Coeliac disease is a chronic autoimmune disorder that primarily affects the small intestine. It is triggered by the consumption of gluten, a protein found in wheat, barley, and rye.
• Pathophysiology: In people with coeliac disease, the immune system reacts abnormally to gluten, leading to inflammation and damage to the lining of the small intestine.
• Clinical Features: Symptoms can vary widely but often include diarrhoea, abdominal pain, bloating, weight loss, and malnutrition due to malabsorption.
• Diagnosis: The diagnosis is usually based on a combination of symptoms, blood tests for coeliac-specific antibodies (anti-tissue transglutaminase and endomysial antibodies), and a biopsy of the small intestine showing characteristic changes.
• Treatment: The main treatment for coeliac disease is a strict, lifelong gluten-free diet, which allows the intestinal lining to heal and alleviates symptoms. In some cases, additional treatments may be required to manage complications.
• Prognosis: With strict adherence to a gluten-free diet, most people with coeliac disease can lead a normal, healthy life. However, non-compliance with the diet can lead to complications such as osteoporosis, infertility, neurological conditions, and a small increased risk of certain cancers.

Answer Explanation:

• The correct answer is ‘Splenic atrophy may be a feature’. This is because coeliac disease can lead to hyposplenism (poor functioning of the spleen), which can result in splenic atrophy. This is due to the chronic inflammation and malabsorption caused by the disease.
• ’90 per cent of cases present in teenage years’ is incorrect as coeliac disease can present at any age, not just in teenage years.
• ‘There is an association with smoking’ is also incorrect. There is no established link between smoking and coeliac disease.
• ‘Malabsorption is a rare complication’ is incorrect. Malabsorption is a common feature of coeliac disease, not a rare complication.
• ‘There is an association with dermatitis artefacta’ is incorrect. Dermatitis herpetiformis, not dermatitis artefacta, is associated with coeliac disease.

Overview of Coeliac Disease:

• Definition: Coeliac disease is a chronic, immune-mediated disorder that primarily affects the small intestine in genetically predisposed individuals. It is triggered by the ingestion of gluten, a protein found in wheat, barley, and rye.
• Pathophysiology: In coeliac disease, the immune system reacts abnormally to gluten, leading to inflammation and damage to the lining of the small intestine. This impairs nutrient absorption.
• Clinical Features: Symptoms can vary widely but commonly include diarrhoea, abdominal pain, bloating, weight loss, and malnutrition. Some patients may present with symptoms related to complications such as anaemia, osteoporosis, or neurological problems.
• Diagnosis: Diagnosis is based on a combination of serological tests (anti-tissue transglutaminase antibodies) and histological findings on duodenal biopsy (villous atrophy).
• Treatment: The mainstay of treatment is a lifelong gluten-free diet, which allows the gut to heal and symptoms to improve.
• Complications: Complications can include malabsorption, osteoporosis, infertility, neurological complications, and a small increased risk of certain types of cancer. Hyposplenism is also a recognised complication.