Coeliac's

Immune-mediated inflammatory systemic disorder provoked by gluten and related prolamine, specifically gliadin.

This affects the jejunal of the small intestines

This is found in wheat, rye and barley

Presentation
It may present at any age 8-24 months is common, after weaning on gluten foods

Associated with Dermatitis herpetiformis

Symptoms
In practice features can be mild and non specific causing growth failure
 * FTT
 * abdo distention
 * buttock wasting
 * general irritability

Identify high risk

 * DM1
 * Autoimmune thyroid disease
 * Down's syndrome
 * 1o relative with coeliac's
 * IBS in adults

Biopsy
Mucosal changes:
 * Increased intraepithelial lymphocytes
 * Villous atrophy
 * Crypt hypertrophy

Serology
IgA tissue transglutamase and endomysial antibodies

Testing in anyone with

 * Who have persistent unexplained abdominal or gastrointestinal symptoms.
 * Who have faltering growth.
 * With prolonged fatigue.
 * With unexpected weight loss.
 * With severe or persistent mouth ulcers.
 * Who have unexplained iron, vitamin B12 or folate deficiency.