Coeliac disease
Description
- Immune-mediated enteropathy triggered by gluten (wheat, rye, barley) in HLA-DQ2/DQ8-positive individuals
- Proximal small bowel disease -> villous atrophy -> malabsorption of iron, folate, calcium, fat-soluble vitamins
- Oats are tolerated by most, but are commonly contaminated during processing
Presentations
| Classical | Diarrhoea, steatorrhoea, weight loss, failure to thrive |
| Non-classical (most adults) | Iron deficiency anaemia, osteoporosis, fatigue, abnormal LFTs, infertility, neurological symptoms, dyspepsia, IBS-like |
| Subclinical | Detected on screening in a risk group |
| Potential | Positive serology + HLA, normal biopsy |
| Refractory | Persistent symptoms and villous atrophy despite >12 months of strict gluten-free diet |
- *Most Australian adults with coeliac disease do not have diarrhoea* - waiting for it delays the diagnosis by years
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