Coeliac disease

*from Greek κοιλιακοc 'abdominal cavity'

Definition: inflammatory disorder of small intestine caused by prolamins (gliadins—wheat, hordeins—barley, secalins—rye).

Epidemiology

0-5aet. or 50-60aet. M<F (difference is small). 1/3 asymptomatic. Highest prevalence in West of Ireland (1:300). Does not affect native Africans, Chinese, Japanese, &c. HLA B8, DR3, DQw2. Concordance between MZ twins is 70%. Dermatitis herpetiformis. Adenovirus 12? (protein E1b cross reacts with α-gliadin antibodies)

Features

Pathology

Subtotal subvillous atrophy. Infiltration by plasma cells, mast cells, lymphocytes, neutrophils, eosinophils.

Diagnosis

Biopsy at duodenojejunal junction with Crosby capsule or endoscope.

Investigations

Complications

Pathology

Humoral: circulating IgA and IgG anti-gliadin.

Cell-mediated: Intraepithelial cytotoxic T-cells.

Associations

Treatment

Life-long gluten free diet. (Check compliance with α-gliadin antibodies.) Should see response (symtomatic & histological) in 1–2 weeks. If not gluten challenge and re-biopsy.

ΔΔx

Collagenous sprue, lymphoma.

Other causes of subtotal villous atrophy: cow's milk intolerance, soya bean protein intolerance, acute infective gastroenteritis, giardiasis, eosinophilic gastroenteritis, malignancy, CMV.