Immune-mediated enteropathy triggered by gluten in genetically susceptible (HLA-DQ2/DQ8) individuals.
Clinical features
- • Diarrhoea, bloating, weight loss
- • Iron or folate deficiency anaemia
- • Dermatitis herpetiformis
- • Osteoporosis, infertility, transaminitis
Investigations
- • Anti-tTG IgA with total IgA — while still eating gluten
- • Duodenal biopsy (Marsh grading) for confirmation in adults
- • Bone density, iron, B12, folate, vitamin D
Management
- • Lifelong strict gluten-free diet with dietitian support
- • Correct micronutrient deficiencies
- • Pneumococcal vaccination (functional hyposplenism)
- • Repeat serology at 6 and 12 months
Clinical pearls
- • Persistent symptoms usually mean gluten exposure — reassess before labelling refractory coeliac disease
- • Screen first-degree relatives and type 1 diabetics
Educational — verify locally.
