Overview Coeliac disease is a systemic autoimmune disease triggered (T-lymphocytes) by dietary gluten peptides found in wheat, rye, barley, and related grains. Immune activation in the small intestine leads to villous atrophy, hypertrophy of the intestinal crypts, and increased numbers of lymphocytes in the epithelium and lamina propria. Locally these changes lead to gastrointestinal symptoms and malabsorption. The disease is common (1/~1000) and is more common in the Irish.
Definition Coeliac Disease: Inflammatory process, which occurs in susceptible individuals in response to the ingestion of wheat protein (gluten and gliadin) Gliadin: A glycoprotein (a carbohydrate plus a protein) within gluten |
Watch Coeliac Disease DETAILED Overview |
The small intestine is divided into three sections: Duodenum, Jejunum and Ileum.
The three sections of the small intestine
Blood Supply (branches of the celiac trunk)
Blood supply (3/5 branches of the superior mesenteric artery)
Watch: Carbohydrate digestion and absorption |
Watch: Protein digestion and absorption |
Clinical Presentation
Side Note Coeliac disease is associated with Type II diabetes (10%) and Genetic disorders such as Down's Syndrome (12%) |
Clinical Examination - Usually normal, signs are seen in severe cases
Remember Suspect Coeliac Disease in all those with diarrhoea + weight loss or anaemia (esp. if iron or B12 ). |
Childhood other food-sensitive enteropathies (milk sensitivity)
Adults
Remember Exclude coeliac disease in all diagnosed with irritable bowel syndrome |
Diagnosis Small Bowel Histological changes including:
Macroscopic
Microscopic
General
Coeliac crisis management - Medical Emergency
Complications
Dermatitis Herpetiformis: Very itchy/“burning” blisters on elbows, scalp, shoulders, ankles Image source dermnetnz.org |
Prognosis