Coeliac Disease

Eileen Parrott

Very common. We all miss opportunities to diagnose. At least 1% of population. Runs in families. Peak incidence currently mid 50s. More common in women (3:1).

Gluten Sensitive Enteropathy

Only 5% present with the classic symptoms:- Diarrhoea Weight loss Fatigue

In children get:- Failure to thrive when weaned Diarrhoea Abdominal bloating Buttock wasting

Presentation

Anybody with GI symptoms Abdo pain Diarrhoea Steatorrhoea Bloating Mouth ulcers Dyspepsia Poor appetite

Anybody with unexplained non GI symptoms

Weight loss Fatigue Arthralgia Myalgia Neuropathy Ataxia Iron deficiency anaemia

When To Consider Coeliac

Dermatitis Herpetiformis Itchy, blistering skin eruption to knees,

elbows, buttocks and back. Affects 1/10,000 with coeliac.

Consequences

If undiagnosed, may develop:- Infertility and miscarriage Osteoporosis (at diagnosis 40%

osteopaenia). Need DEXA. T cell lymphomas of small bowel (red

flag is symptom recurrence despite gluten free diet).

All tests loose their usefulness if patient has already started a gluten free diet.

Serological testing. Endomysial antibodies Tissue transglutaminase antibodies Both of these are more sensitive than

antigliadin antibodies

Diagnosis

Positive antibody test needs a gastro referral.

Diagnosis is confirmed with endoscopy and multiple duodenal biopsies.

Patient must continue to eat gluten until biopsies are done.

Endoscopy

Permanent gluten free diet. Clinical improvement within weeks. Exclude wheat, barley, rye. Some also argue need to exclude oats

(as 20% are contaminated with wheat). Expert dietician input required. Patient adherence poor (only around

60%).

Management

Wide variety available on prescription.

Based on monthly calculated units. Adult male 18 Adult female 14

One Unit is:- 400g bread 250g flour

200g biscuits 250g pasta

Prescriptions

Thank YouAny Questions?