Dr Nader Ghaderi, GPR

General informationFirst described in ancient Greek by Aretaeus

of CappadociaThe word Coeliac was first used in 19th

century in a translation and was derived from the Greek word koiliakos meaning abdominal.

Many other names: Celiac disease, coeliac sprue, non-tropical sprue, gluten enteropathy, endemic sprue, ….

Coeliac disease Autoimmune disorderHeightened immunologic response to ingested

gluten in genetically susceptible peopleMore prevalent than previously thought: 2.4%

in Finland, less in the UK and Germany Usually GI symptomsOther symptoms are increasingly being

recognisedSome patient may have no symptomsOften coexists with other conditions

Pathology: No signs or symptoms before starting gluten in

dietInflammatory reaction in small bowel following

ingestion of gluten, caused by immune reaction to modified gliadin( the protein in gluten) by tTGA

Villous atrophy caused by this autoimmune reaction

Villous atrophy causes malabsorption The only effective life-long treatment is gluten-

free diet

NICE recommendation:

Offer serological testing to children and adults with any of the following signs, symptoms and conditions:

Signs and symptoms: Chronic or intermittent diarrhoeaFailure to thrive or faltering growth in childrenPersistent or unexplained GI symptoms

including nausea and vomitingProlonged fatigue ( “tired all the time”)Recurrent abdominal pain, cramping or

distensionSudden or unexpected weight lossUnexplained iron deficiency anaemia or other

unspecified anaemia

Conditions:

Autoimmune thyroid diseaseDermatitis herpetiformisIBSDM type I

NICE recommends:Consider offering serological tests to children

and adults with any of the following conditions:Addison’s diseaseAmenorrhoeaAphtous stomatitis ( mouth ulcers)Atuimmune liver conditionsAutoimmune myocarditisChronic thrombocytopaenic purpuraDental enamel defects

Also :Depression or bipolar disorderDown’s syndromeEpilepsyLow trauma fractureLymphomaMetabolic bone disease such as rickets or

osteomalaciaMicroscopic colitisPersistent or unexplained constipationPersistent raised liver enzymes with unknown

cause

And: PolyneuropathyRecurrent miscarriageReduced bone mineral densitySarcoidosisSjogren’s diseaseTurner syndromeUnexplained alopeciaUnexplained subfertility

Serological tests:IgA tTGA as first testEMA if above test equivocalIgA deficiency test if IgA tTGA negativeIf IgA deficient then IgG tTGAIf serology positive refer to

gastroenterologist for further investigations and biopsy

If serology negative and high clinical suspicion refer to GI

If serology negative and low clinical suspicion then coeliac disease is unlikely

Prior to serology or biopsy:To have an accurate test, patient should be

taking gluten in diet:Should eat some gluten in more than one

meal every day for at least 6 weeks before testing

They should not start a gluten-free diet until the diagnosis is confirmed by biopsy.

Gluten containing food:WheatBarleyRyeWheat subspecies like: semolina, spelt,

durum, Small minority of patients may react to oat,

likely due to contamination during food processing, pure forms are available.

Gluten free foods:MaizeWild rice Non-cereal carbohydrate rich foods like

potatoes and bananas. Processed food available

Resourceshttp://www.coeliac.org.uk/gluten-free-diet-life

style/food-on-prescription details the monthly quantities and types of gluten free foods a GP may can prescribe

Lots of useful information from recipes to advice for healthcare professionals http://www.coeliac.org.uk/coeliac-disease

The review appointment checklist http://www.coeliac.org.uk/healthcare-professionals/management-of-coeliac-disease/review-appointment-checklist