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Coeliac Disease -
Coeliac Clinical Presentation
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Written by Dr Sebastian Zeki
MCQs for this page
Coeliac Clinical Presentation
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Small bowel histology:
Chronic inflammatory infiltrate in lamina propria.
Lymphocytes in epithelium.
Decreased epithelial cell surface height.
Loss of height.
Crypt hyperplasia.
Written by Dr Sebastian Zeki
Celiac intestinal lesion and symptoms not correlated.
Upper jejunal mucosal immunopathology
Atrophic
hyperplastic
Flat
destructive
Infiltrative
Hyperplastic 2
Infiltrative 1
Pre-infiltrative 0
Histopathology
Endoscopic Types:
Marsh stage 0 which is normal mucosa.
Marsh stage 1which is an increased number of intra-epithelial
lymphocytes, usually exceeding 20 per 100 enterocytes.
Marsh stage 2 whuch us a proliferation of the
crypts
of
Lieberkuhn.
Marsh stage 3 which is a partial or complete villous atrophy.
Marsh stage 4 which is hypoplasia of the small bowel architecture.
Autoimmune diseases
(eg,
Type 1 diabetes mellitus,
collagen vascular disease,
autoimmune thyroiditis) may
reach > 30 % of patients
diagnosed after age 20
Risk Of Malignancy
Increased risk of
Non-Hodgkin's lymphoma and
GI cancers increased mdoer
-
ately
Risk of Non-Hodgkins
continues for 5 years after
diagnosis
Breastand possibly lung cancer
risk appears to be decreased.
Non-GI Manifestations
GI Manifestations
Malabsorption symptoms:
Growth failure in children
Weight loss
Severe anemia
Neurologic disorders from
deficiencies of B vitamins
Osteopenia from deficiency of
vitamin D and calcium
Flatulence
Meteorism (due to colonic bacterial
digestion of malabsorbed nutrients).
Diarrhea with bulky, foul-smelling,
floating stools due to steatorrhea
Malabsorption
Kidney disease
Glomerular IgA deposition is
common, occurring in as many as
one-third of patients.
Usually no clinical manifestation
Hyposplenism
Known association although pathology unknown
Prophylactic
pneumococcal
vaccination has been
suggested.
Metabolic bone disease
Common to have porosis/ peonia
Can occur in asymptomatics.
Due to secondary
hyperparathyroidism
secondary
to vit D deficiency.
May not reach normality with gluten free diet
Risk of fractures is only slightly increased .
Arthritis
Arthritis in 41 % in patients on a regular diet to 22
% in those on a gluten-free diet .
Can be peripheral or axial or both
Histological Lesions:
Type 0 lesion involves a mild alteration characterized by increased
intraepithelial lymphocytes.
Type 3 lesion involves a flat mucosa with total mucosal atrophy,
complete loss of villi, enhanced epithelial apoptosis and crypt
hyperplasia .
Type 4 lesion are characteristic of T cell
lymphomas.
Type 4 lesions have the same histologic features seen in the type 3
lesion except that lamina propria hyperplasia becomes hypoplasia.
Neuropsychiatric disease
Primary manifestation of CD may be neuropsychiat
-
ric symptoms such as
ataxia,
depression, anxiety, or
epilepsy .
Up to 60% of idiopathic
ataxia
may have coeliac
Pathogenesis may be: Regional hypoperfusion or
presence of IgA tissue transglutaminase deposition
around cerebellar vessels.
Coeliac Disease- Clinical manifestations
Clinical Manifestations
Ages 10-40
Subclinical
disease
Can exist in a very mild form
and may go largely
undetected.
Severity of disease may be
weakly correlated with the
level of TTG IgA.
Risk of malignancy with
subclinical coeliac disease is
not known- is lower if dont
have malabsorption.
Risk becomes normal on
gluten-free diet.
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