Inflammatory condition induced by the ingestion of gluten (protein found in wheat, barley and rye)

Aetiology

• Genetically linked auto-immune disorder
  • Genetic susceptibility + trigger (trigger currently unknown, possibly enteric virus)
  • HLADQ2/HLADQ8 gene - code for type II MHC molecules
• Average age of diagnosis - 40-60 years

Pathophysiology

• Not an allergy - T cell/IEL mediated
• Activated T cells and IELs kill epithelial cells
• Causes damage to small intestine, leading to malnutrition
• Damage is reversible (usually) - damaged enterocytes are replaced by normal ones when patients stop eating gluten

Clinical features

• 1/3 asymptomatic

Symptoms

• General malaise/tiredness - often duet iron deficiency anaemia
• Diarrhoea
• Nausea and vomiting
• Bloating
• Weight loss
• Oral ulceration

Signs

• Dermatitis herpetiformis - itchy blisters caused by subepithelial IgA deposition