Coeliac Disease

Pathology affects mucosa of small intestine
Impaired nutrient absorption
Improves on withdrawal of wheat gliadins & related grain proteins from diet

3 Features

1. Small Intestine
2. Malabsorption
3. Iimproves with removal of wheat gliadins from diet.

Aetiology
*Caucasian (Irish = 1/100)
Genetic: HLA DQw2 locus
Imm-med I inj with malab

Ix
Serum
Antiendomysial antibodies
Antigliadins
Biopsy
Confirm positive aBs
Macro
Mucosa smooth
Changes prominent in proximal > distal sm I
Micro
Flattening of villi (villous atrophy)
Lengthening of crypts
Resembles colonic mucosa
Intraepithelial lymphocytosis (*cytotox T cells & up nos. of T helper cells within Lprop)

Tx
Remove wheat gliadins & related grain proteins from diet
Confirm Dx
 - 2nd biopsy post diet (n villous architecture)/gluten challenge
 - decrease in symptoms to confirm

Cx
Up risk - T cell lymphoma
Malignancies of GI Tract & Breast