Coeliac Disease Overview

Coeliac Disease

• People with coeliac disease are reactive to the gliadin in gluten.
• The large gliadin peptides are normally absorbed by enterocytes and do not cause any problems.
• In coeliac disease, the gliadin peptides enter the lamina propria of the small intestine and initiate an immune response.
• A T cell mediated autoimmune inflammatory reaction results in marked atrophy or total loss of villi.
• There is a granular appearance of duodenal folds and a loss of villi in coeliac disease.
• Severe symptoms can cause anemia due to severe malabsorption.
• Malabsorption can also result in major vitamin deficiencies, causing neurological conditions, osteopenia, and severe metabolic disturbances.
• Untreated coeliac disease increases the risk for T cell lymphoma.
• Gluten needs to be totally removed from the diet.
• Even trace amounts can cause changes to the gastrointestinal mucosa.
• Increased risk of T cell lymphoma with non-compliance.
• Foods that most people don’t realize contain gluten: beer, stock cubes, chewing gum, some lollies, icecream, processed meats, tomato sauce and other condiments, hot chips etc.

Oesophageal Varices

• Enlarged veins in the oesophagus.
• These can be diagnosed via endoscopy.
• Life-threatening complication of portal hypertension.
• Seen in up to 50% of patients with liver disease such as liver cirrhosis.
• 25-40% of sufferers will experience bleeding. 15% of these will die from blood loss.
• There are no symptoms until they rupture.
• Signs of bleeding can include vomiting of blood, dark or tarry stools.
• Signs of blood loss: lightheadedness, confusion, loss of consciousness.
• Caused by obstructed blood flow through the portal vein.
• Cirrhosis of the liver can result in portal hypertension, where blood flow is backed up.
• Increased pressure causes veins of the esophagus to become dilated and swollen.
• Lifestyle modifications: weight loss, stopping all alcohol.
• Medication to lower blood pressure: beta blockers.
• Surgery: variceal band ligation.

Gastro-oesophageal Reflux Disease (GORD)

• Gastroesophageal reflux disease (GORD/GERD) is when stomach acid or bile is not contained within the stomach and repeatedly flows back into the oesophagus.
• Prevalence: 10-20% of the population in Western countries.
• Common in people aged 40+.
• Symptoms: Heartburn, pain often worse after eating, when lying down, and with emotional stress.
• Regurgitation of sour-tasting gastric content.
• Nausea, burping.
• Dry cough and sore throat.
• Poor oesophageal clearance: efficient peristalsis and saliva production limits the exposure of the oesophagus to the acid and bile in the stomach.
• Dysfunctional lower oesophageal sphincter (LOS): The LOS relaxes to allow the passage of food into the stomach and closes to protect the oesophagus from the acid in the stomach.
• Alcohol and smoking, obesity, pregnancy, smoking.