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Published byBaldric Bishop Modified over 9 years ago
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Coeliac Disease Eileen Parrott
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Very common. We all miss opportunities to diagnose. At least 1% of population. Runs in families. Peak incidence currently mid 50s. More common in women (3:1). Gluten Sensitive Enteropathy
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Only 5% present with the classic symptoms:- Diarrhoea Weight loss Fatigue In children get:- Failure to thrive when weaned Diarrhoea Abdominal bloating Buttock wasting Presentation
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Anybody with GI symptoms Abdo painDiarrhoeaSteatorrhoea BloatingMouth ulcersDyspepsia Poor appetite Anybody with unexplained non GI symptoms Weight lossFatigueArthralgia MyalgiaNeuropathyAtaxia Iron deficiency anaemia When To Consider Coeliac
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Dermatitis Herpetiformis Itchy, blistering skin eruption to knees, elbows, buttocks and back. Affects 1/10,000 with coeliac.
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Consequences If undiagnosed, may develop:- Infertility and miscarriage Osteoporosis (at diagnosis 40% osteopaenia). Need DEXA. T cell lymphomas of small bowel (red flag is symptom recurrence despite gluten free diet).
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All tests loose their usefulness if patient has already started a gluten free diet. Serological testing. Endomysial antibodies Tissue transglutaminase antibodies Both of these are more sensitive than antigliadin antibodies Diagnosis
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Positive antibody test needs a gastro referral. Diagnosis is confirmed with endoscopy and multiple duodenal biopsies. Patient must continue to eat gluten until biopsies are done. Endoscopy
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Permanent gluten free diet. Clinical improvement within weeks. Exclude wheat, barley, rye. Some also argue need to exclude oats (as 20% are contaminated with wheat). Expert dietician input required. Patient adherence poor (only around 60%). Management
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Wide variety available on prescription. Based on monthly calculated units. Adult male 18Adult female 14 One Unit is:- 400g bread250g flour 200g biscuits250g pasta Prescriptions
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Thank You Any Questions?
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