Coeliac disease

COELIAC DISEASE

INTRODUCTION

It is a T cell mediated autoimmune disorder of the small bowel in which protamine causes villous atrophy and malabsorption.

It is basically sensitivity to gluten containing foods. Gluten is a protein.

PATHOGENESIS

In coeliac disease, the immune response to gluten creates toxins that destroy the villi. Villi are tiny finger-like protrusions inside the small intestines. When the villi become damaged, the body is unable to absorb nutrients from food. This can lead to malnutrition and other serious health complications, including permanent intestinal damage and iron deficiency anaemia.

SIGNS AND SYMPTOMS

Intermittent diarrhea
Steatorrhea (Pale, fatty stools, foul smelling, difficult to flush)
Abdominal Pain
Fatigue
Failure to thrive in children
Weight loss
Weakness
Iron deficiency anemia
Dermatitis herpetiformis (DH) is another common symptom of celiac disease. DH is an intensely itchy skin rash made up of bumps and blisters. It may develop on the elbows, buttocks, and knees. DH affects approximately 15 to 25 percent of people with celiac disease. Those who do experience DH usually don’t have digestive symptoms.

RISK FACTORS

People who have other autoimmune diseases and certain genetic disorders are also more likely to have coeliac disease. Some conditions associated with celiac disease include:

Lupus
Rheumatoid arthritis
Type 1 diabetes
Thyroid disease
Autoimmune liver disease
Addison’s disease
Sjogren’s syndrome
Down syndrome
Turner syndrome
Lactose intolerance

DIAGNOSIS

Complete Blood count (CBC)
Liver function tests
Cholesterol test
Alkaline phosphatase level test
Serum albumin test
Anti endomysial antibodies
Anti transglutaminase: Most commonly done

If tissue transglutaminase antibody is positive then biopsy is taken from small intestine which shows villous hypertrophy and crypt hyperplasia. Gold standard diagnosis is biopsy.

For biopsy to be accurate, patient should re introduce gluten for 6 weeks before biopsy.