Understanding Coeliac Disease

Summary

In this video, Tom from Zero2Finals provides an in-depth overview of celiac disease, an autoimmune disorder triggered by gluten that leads to inflammation in the small intestine. The video covers symptoms, including failure to thrive in children, diarrhea, fatigue, and dermatitis herpetiformis. Tom explains key diagnostic tests, such as anti-tissue transglutaminase (anti-TTG) and anti-endomesial antibodies (anti-EMA), and the importance of confirming with an endoscopy and biopsy. Treatment involves a strict, lifelong gluten-free diet. The video also highlights associations with other autoimmune conditions and complications like osteoporosis and enteropathy-associated T-cell lymphoma (EATL).

Takeaways

• 😀 Celiac disease is an autoimmune condition triggered by gluten exposure, causing inflammation in the small intestine and leading to malabsorption of nutrients.
• 😀 The condition typically develops in childhood but can emerge at any age.
• 😀 Two key autoantibodies are associated with celiac disease: anti-tissue transglutaminase (anti-TTG) and anti-endomysial antibodies (anti-EMA).
• 😀 The presence of these autoantibodies can help determine disease activity, rising and falling depending on how active the disease is.
• 😀 Symptoms of celiac disease can include failure to thrive in children, diarrhea, fatigue, weight loss, mouth ulcers, anemia, and dermatitis herpetiformis (an itchy blistering rash).
• 😀 Celiac disease can also present with neurological symptoms such as peripheral neuropathy, cerebellar ataxia, and epilepsy.
• 😀 Celiac disease is often tested in patients with type 1 diabetes, as both conditions are frequently linked.
• 😀 Genetic predisposition plays a role, with two key genes (HLA-DQ2 and HLA-DQ8) commonly associated with the disease.
• 😀 To diagnose celiac disease, blood tests for anti-TTG and anti-EMA are used, but tests should be done while the patient is still consuming gluten to avoid false negatives.
• 😀 A definitive diagnosis can be made via endoscopy with biopsies, showing crypt hypertrophy and villus atrophy in the small intestine.
• 😀 Untreated celiac disease can lead to severe complications such as vitamin deficiencies, osteoporosis, ulceration in the jejunum, and an increased risk of cancers like enteropathy-associated T-cell lymphoma and small bowel adenocarcinoma.
• 😀 The primary treatment for celiac disease is a lifelong gluten-free diet, which can resolve symptoms and prevent relapse.

Q & A

What is celiac disease?

Celiac disease is an autoimmune disorder in which exposure to gluten triggers an immune response that causes inflammation in the small intestine, leading to malabsorption of nutrients.

At what age does celiac disease typically develop?

Celiac disease usually develops in early childhood but can appear at any age.

Which antibodies are commonly associated with celiac disease?

The two main antibodies associated with celiac disease are anti-tissue transglutaminase (anti-TTG) and anti-endomysial antibodies (anti-EMA).

What does inflammation in the jejunum lead to in celiac disease?

Inflammation in the jejunum causes atrophy of the intestinal villi, which impairs nutrient absorption and leads to malabsorption symptoms.

What are some common symptoms of celiac disease in children?

In children, common symptoms include failure to thrive, diarrhea, and poor weight gain.

What is dermatitis herpetiformis and its relation to celiac disease?

Dermatitis herpetiformis is an itchy, blistering rash that typically appears on the abdomen and is strongly associated with celiac disease.

How can celiac disease affect patients with type 1 diabetes?

There is a common association between type 1 diabetes and celiac disease. It is recommended to test for celiac disease in all patients with type 1 diabetes, even if they are asymptomatic.

What genetic factors are linked to celiac disease?

The two main genetic factors associated with celiac disease are the HLA-DQ2 and HLA-DQ8 genes.

What are some potential complications of untreated celiac disease?

Untreated celiac disease can lead to vitamin deficiencies, anemia, osteoporosis, ulceration of the jejunum, and an increased risk of cancers such as enteropathy-associated T-cell lymphoma and small bowel adenocarcinoma.

How is celiac disease diagnosed?

Celiac disease is diagnosed through blood tests for anti-TTG and anti-EMA antibodies. If these tests are inconclusive, an endoscopy with intestinal biopsies showing crypt hypertrophy and villus atrophy can confirm the diagnosis.

What is the primary treatment for celiac disease?

The primary treatment for celiac disease is a strict, lifelong gluten-free diet, which can help heal the intestine and prevent relapse of symptoms.

What should be tested in patients with suspected IgA deficiency when testing for celiac disease?

In patients with suspected IgA deficiency, total immunoglobulin A (IgA) levels should be tested to avoid false-negative results. If IgA levels are low, IgG versions of anti-TTG and anti-EMA antibodies can be used for testing, or an endoscopy can be performed.