Dr Nader Ghaderi, GPR. General information First described in ancient Greek by Aretaeus of...
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Transcript of Dr Nader Ghaderi, GPR. General information First described in ancient Greek by Aretaeus of...
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