1. Coeliac Disease

2. What is Coeliac disease? Autoimmune Heightened immunological response to ingested GLUTEN In genetically susceptible people

3. NICE suggest 1 in 100 people have CD Often co-exists with other conditions Gluten in - WHEAT, RYE, BARLEY Gluten is NOT in oats, rice and maize

4. Commonest cause of generalised malabsorption in Western Europe Childhood = commonest presentation Adults – women (40-50) and men (50-60) Associated with HLA-B8 and HLA-A1

5. HIGH RISK GROUPS 1 st degree relative with CD Autoimmune THYROID disease Type 1 DM IBS Dermatitis herpetiformis Down’s syndrome

6. Presentation in children (6m – 2y) Chronic diarrhoea Steatorrhoea Abdominal distention FTT Frequently - irritable, anorexic

7. Presentation in adults (60% asymptomatic) Malaise, weakness, weight loss Diarrhoea, steatorrhoea, abdo. Distension + pain Iron and folate deficiency Skin rashes

8. Investigations Haematology – blood film, MCV, clotting Biochemistry – LFTs, ferritin, Vit. D, Calcium Immunology - Endomysial antibodies, TTG, IgA Jejunal biopsy

9. Diagnosis Refer to Gastroenterologist Confirmed by Jejunal biospy

10. Management Gluten-free diet – dietician input Counselling Coeliac society Follow-up – symptoms, bloods, complications