1. Coeliac Disease Eileen Parrott

2. Very common. We all miss opportunities to diagnose. At least 1% of population. Runs in families. Peak incidence currently mid 50s. More common in women (3:1). Gluten Sensitive Enteropathy

3. Only 5% present with the classic symptoms:- Diarrhoea Weight loss Fatigue In children get:- Failure to thrive when weaned Diarrhoea Abdominal bloating Buttock wasting Presentation

4. Anybody with GI symptoms Abdo painDiarrhoeaSteatorrhoea BloatingMouth ulcersDyspepsia Poor appetite Anybody with unexplained non GI symptoms Weight lossFatigueArthralgia MyalgiaNeuropathyAtaxia Iron deficiency anaemia When To Consider Coeliac

5. Dermatitis Herpetiformis Itchy, blistering skin eruption to knees, elbows, buttocks and back. Affects 1/10,000 with coeliac.

6. Consequences If undiagnosed, may develop:- Infertility and miscarriage Osteoporosis (at diagnosis 40% osteopaenia). Need DEXA. T cell lymphomas of small bowel (red flag is symptom recurrence despite gluten free diet).

7. All tests loose their usefulness if patient has already started a gluten free diet. Serological testing. Endomysial antibodies Tissue transglutaminase antibodies Both of these are more sensitive than antigliadin antibodies Diagnosis

8. Positive antibody test needs a gastro referral. Diagnosis is confirmed with endoscopy and multiple duodenal biopsies. Patient must continue to eat gluten until biopsies are done. Endoscopy

9. Permanent gluten free diet. Clinical improvement within weeks. Exclude wheat, barley, rye. Some also argue need to exclude oats (as 20% are contaminated with wheat). Expert dietician input required. Patient adherence poor (only around 60%). Management

10. Wide variety available on prescription. Based on monthly calculated units. Adult male 18Adult female 14 One Unit is:- 400g bread250g flour 200g biscuits250g pasta Prescriptions

11. Thank You Any Questions?