Investigations

Coeliac Disease – Investigations
Blood Tests
- serology by blood test; useful in diagnosing and excluding coeliac disease
- 4 types: modern – IgA antibodies against endomysium or tissue transglutaminase
older – IgA antibodies against reticulin or gliadin
- should still be followed by an endoscopy
- based on indirect immunofluorescence or ELISA
- total serum IgA level should be checked as some patients may have IgA deficiency

Endoscopy
- upper endoscopy with biopsy of the distal duodenum or proximal jejunum should be performed
- important to obtain multiple samples from the duodenum because not all areas equally affected (false negative)
- most have a small bowel that appears normal on endoscopy; main findings are scalloping of the small bowel folds, paucity in the folds, mosaic pattern to the mucosa, prominence of the submucosal blood vessels, and a nodular pattern to the mucosa
The classic pathology changes of coeliac disease in the small bowel are categorized by the "Marsh classification":
- Marsh stage 0: normal mucosa
- Marsh stage 1: increased number of intra-epithelial lymphocytes, usually exceeding 20 per 100 enterocytes
- Marsh stage 2: proliferation of the crypts of Lieberkuhn
- Marsh stage 3: partial or complete villous atrophy
- Marsh stage 4: hypoplasia of the small bowel architecture

Other tests
- full blood count
- electrolytes
- calcium
- renal function
- liver enzymes
- vitamin B12
- folic acid level
- coagulation tests (PT & aPTT) for vitamin K deficiency

(Posted by: Vivian)

Prognosis & Complications of Celiac Disease

Prognosis

Prognosis for celiac disease is generally good. For most people, following a gluten-free diet plan will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvements begin within days of starting the diet. The small intestine is usually completely healed in 3 to 6 months in children and younger adults and within 2 years for older adults. Healed means a person now has villi that can absorb nutrients from food into the bloodstream.

However, sometimes, depending on a person’s age at diagnosis, some problems will not improve, such as delayed growth and tooth discoloration. For example, young patients who are diagnosed with celiac disease after their growth period will continue to have a short stature.

Some people with celiac disease show no improvement on the gluten-free diet. This condition is called unresponsive celiac disease. The most common reason for poor response is that small amounts of gluten are still present in the diet. Advice from a dietitian who is skilled in educating patients about the gluten-free diet is essential to achieve the best results.

Rarely, the intestinal injury will continue despite a strictly gluten-free diet. People in this situation have severely damaged intestines that cannot heal. Because their intestines are not absorbing enough nutrients, they may need to receive nutrients directly into their bloodstream through a vein, or intravenously. People with this condition may need to be evaluated for complications of the disease. Researchers are now evaluating drug treatments for unresponsive celiac disease.

Complications of celiac disease

Complications of Celiac Disease are secondary conditions, symptoms, or other disorders that are caused by Celiac Disease. In many cases the distinction between symptoms of Celiac Disease and complications of Celiac Disease is unclear or arbitrary.

Damage to the small intestine and the resulting nutrient absorption problems put a person with celiac disease at risk for several diseases and health problems.

Some of the more common ones are listed below:

· Anaemia caused mainly by deficiencies in iron and vitamin B12 absorption.
· Lymphoma and adenocarcinoma are cancers that can develop in the intestine.
· Osteoporosis caused by poor calcium absorption.
· Miscarriage and congenital malformation of the baby, such as neural tube defects, are risks for pregnant women with untreated celiac disease because of nutrient absorption problems.
· Short stature results when childhood celiac disease prevents nutrient absorption during the years when nutrition is critical to a child’s normal growth and development. Children who are diagnosed and treated before their growth stops may have a catch-up period.
· Seizures, or convulsions, result from inadequate absorption of folic acid. Lack of folic acid causes calcium deposits, called calcifications, to form in the brain, which in turn cause seizures.

Contributed by John Lee

Sources:

National Institute of Diabetes and Digestive and Kidney Diseases (US):
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/#6

WrongDiagnosis.com:
http://www.wrongdiagnosis.com/c/celiac_disease/complic.htm

Labelling our posts

To avoid confusion to differentiate between pcl materials from MED2031 and MED2042 since we start with Week 1 again this semester, I would suggest that we label our work according to the title of the week.

I have entered all the pcl titles under this post and they should appear when you type in the first letter into the label slot. Alternatively, click on Show all to display all the pcl title.

Thanks.

Ji Keon