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Coeliac Disease

Coeliac Disease. Dr Nader Ghaderi, GPR. General information. First described in ancient Greek by Aretaeus of Cappadocia The word Coeliac was first used in 19 th century in a translation and was derived from the Greek word koiliakos meaning abdominal.

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Coeliac Disease

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  1. Coeliac Disease Dr Nader Ghaderi, GPR

  2. General information • First described in ancient Greek by Aretaeus of Cappadocia • The word Coeliac was first used in 19th century in a translation and was derived from the Greek word koiliakos meaning abdominal. • Many other names: Celiac disease, coeliac sprue, non-tropical sprue, gluten enteropathy, endemic sprue, ….

  3. Coeliac disease • Autoimmune disorder • Heightened immunologic response to ingested gluten in genetically susceptible people • More prevalent than previously thought: 2.4% in Finland, less in the UK and Germany • Usually GI symptoms • Other symptoms are increasingly being recognised • Some patient may have no symptoms • Often coexists with other conditions

  4. Pathology: • No signs or symptoms before starting gluten in diet • Inflammatory reaction in small bowel following ingestion of gluten, caused by immune reaction to modified gliadin( the protein in gluten) by tTGA • Villous atrophy caused by this autoimmune reaction • Villous atrophy causes malabsorption • The only effective life-long treatment is gluten-free diet

  5. NICE recommendation: Offer serological testing to children and adults with any of the following signs, symptoms and conditions:

  6. Signs and symptoms: • Chronic or intermittent diarrhoea • Failure to thrive or faltering growth in children • Persistent or unexplained GI symptoms including nausea and vomiting • Prolonged fatigue ( “tired all the time”) • Recurrent abdominal pain, cramping or distension • Sudden or unexpected weight loss • Unexplained iron deficiency anaemia or other unspecified anaemia

  7. Conditions: • Autoimmune thyroid disease • Dermatitis herpetiformis • IBS • DM type I

  8. NICE recommends: Consider offering serological tests to children and adults with any of the following conditions: • Addison’s disease • Amenorrhoea • Aphtous stomatitis ( mouth ulcers) • Atuimmune liver conditions • Autoimmune myocarditis • Chronic thrombocytopaenic purpura • Dental enamel defects

  9. Also : • Depression or bipolar disorder • Down’s syndrome • Epilepsy • Low trauma fracture • Lymphoma • Metabolic bone disease such as rickets or osteomalacia • Microscopic colitis • Persistent or unexplained constipation • Persistent raised liver enzymes with unknown cause

  10. And: • Polyneuropathy • Recurrent miscarriage • Reduced bone mineral density • Sarcoidosis • Sjogren’s disease • Turner syndrome • Unexplained alopecia • Unexplained subfertility

  11. Serological tests: • IgAtTGA as first test • EMA if above test equivocal • IgA deficiency test if IgAtTGA negative • If IgA deficient then IgGtTGA • If serology positive refer to gastroenterologist for further investigations and biopsy • If serology negative and high clinical suspicion refer to GI • If serology negative and low clinical suspicion then coeliac disease is unlikely

  12. Prior to serology or biopsy: To have an accurate test, patient should be taking gluten in diet: • Should eat some gluten in more than one meal every day for at least 6 weeks before testing • They should not start a gluten-free diet until the diagnosis is confirmed by biopsy.

  13. Gluten containing food: • Wheat • Barley • Rye • Wheat subspecies like: semolina, spelt, durum, • Small minority of patients may react to oat, likely due to contamination during food processing, pure forms are available.

  14. Gluten free foods: • Maize • Wild rice • Non-cereal carbohydrate rich foods like potatoes and bananas. • Processed food available

  15. Resources • http://www.coeliac.org.uk/gluten-free-diet-lifestyle/food-on-prescription details the monthly quantities and types of gluten free foods a GP may can prescribe • Lots of useful information from recipes to advice for healthcare professionals http://www.coeliac.org.uk/coeliac-disease • The review appointment checklist http://www.coeliac.org.uk/healthcare-professionals/management-of-coeliac-disease/review-appointment-checklist

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