4mrcp.com

  Coeliac disease is the most common cause of malabsorption syndrome in western world” Prevalence of coeliac disease is estimated to be as high as 1 in 200 in the Western world” which caused by sensitivity to the protein gluten which present in all foods made from wheat, barley or rye and probably oats except: rice, potatoes and corn (maize). IgA antibodies to gliadin are commonly positive in the serum of patients. Serum anti-endomyseal antibody and anti-tissue transglutaminase antibodies are more specific. Repeated exposure leads to villous atrophy which in turn causes malabsorption. About 35% of patients present in the childhood, but it can occur in any age. Mode of presentation is variable with very subtle (failure to thrive, growth retardation or anaemia) or more obvious with fatty diarrhoea and feature of malabsorption.Conditions associated with coeliac disease include dermatitis herpetiformis (a symmetrical vesicular, pruritic skin eruption and IgA deposits are found at dermo-epidermal junction) and autoimmune disorders (type 1 diabetes mellitus and autoimmune hepatitis). It is strongly associated with HLA-DQ2 (95% of patients) and HLA-B8 (80%) as well as HLA-DR3 and HLA-DR7.

The management of coeliac disease is a gluten-free diet   

Classical case of Coeliac Disease

           A 38-year-old man presents with a 8-month history of abdominal bloating, diarrhoea, bone pain, and an itchy vesicles over the extensor surfaces of the forearm . he complains recently from difficulty getting out of his chair. On examination, he has palor with multiple bruises and a symmetrical vesicular rash over his forearms, buttocks and knees.Investigations: Hb: 8.5. WBC: 3.6. Plts: 101. MCV: 97 Blood film: Microcytes, macrocytes, hypersegemented neutrophils and Howell- Jolly bodies.

 Complications of Coeliac Disease

·       Anaemia: iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease)

·      Hyposplenism

·      Lactose intolerance

·      80-fold increase in small bowel carcinoma

·      Oesophageal cancer, other malignancies

·      Collagenous sprue – excessive subepithelial collagen deposition.

·      Lymphocytic gastritis is  a dense epithelial lymphocytic infiltration

·      About 10% of patients with coeliac disease have an isolated immunoglobulin A (IgA) deficiency

·      Associated with chronic liver disease, inflammatory bowel disease, diabetes melliteus, thyroid disease, addison's disease, fibrosing alveolitis, systemic lupus erythematosus, polyarteritis nodosa and temporal lobe epilepsy  

 

 Another case of Coeliac Disease

A 25-year-old woman complains of an itchy symmetrical rash over his arms, tiredness, recurrent abdominal pain and intermittent diarrhoea with a 11-kg weight loss over six months. She is pale and has a rash on her elbows and knees. Laboratory data shows a microcytic, hypochromic anaemia and low folate and ferritin levels, a low serum albumin and slightly raised TSH level and normal free T4.