• 0.5-1% prevalence international

  • onset after infection has not been reported

    • initial onset insult prob infectious

    • associated HLADQ2

  • pain not presenting feature

    • discomfort/bloating

  • 3% of patients meeting Rome criteria unrecognised coeliac disease

Symtoms

  • bloating

  • diarhroea

  • anorexia

  • nausea

  • weightloss

  • maybe mild/nonspecfic

  • often

    • asymptomativc

    • unexplained anaemia

Diagnosis

  • antiendymysial antibodies

    • 97% sensitivity

    • 98% specificity

    • require oesophagus from rhesus monkey or human umbilical cord = substrate

    • test is qualitative

    • can be negatvie

  • antiTTG

    • sens 91-95%

    • NPV near 100%

    • false +

      • liveer disease

      • myeloma

      • monoclonal gamopathy

      • T1DM

    • quicker and cheaper

    • qualatative

    • PPV endomysial and TTG now >90%

    • in NZ igA automatically done - if deficient then igG done

  • coeliac associate with igA deficiency

    • may produduce false negative

  • seronegative can occur

  • biopsy = gold standard

    1. life long dietry change usually has signifiant effect on QoL of people with coeliac disease + financial implications

    2. baseline histology can be useful for later compariosn

      1. especially if no response to change diet

    3. PHARMAC requires biopsy proven diagnosis to approve SA for gluten free products

reduced BMD

  • shown in 40% with coeliac diseaase

  • increase risk of fracture

  • 1.9x

Functional hyposplenism

  • 30% of patients with coeliac disease

    • offer vaccination if evidenc eof hyposplensim on blood film

who should be tested;

  • first degree relatives

  • type 1 dm and other systemic autoimmune disorders

  • patients with IgA deficiency

  • children with down syndrome

  • associated conditions:

    • dermatitis herpetiformis (69-89.5%)

    • recurrent apthouhs ulcers

    • iron deficiency aneamia (2.7-5.7%)

    • irratble bowel (0-11%)

Other tests:

  • BMI

  • symptoms

    • Gi sympotms

    • rashes

    • lethargy

  • bloods:

    • Hb

    • bit b1q2

    • folate

    • iron

    • lfts

    • (vit d)

    • calcium

  • annual check of anti-ttg to assess poor adherence/replase

  • BMD

    • perimenopause

    • 55yo men

    • or any age if # occurs

  • first degree relative

    • 1/10 chance