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Normally, pathogenic bacteria and dietary antigens are prevented from passing through the tight junctions. Changes in permeability have been hypothesised to be an early event in the pathogenesis of coeliac disease. Larazotide may strengthen tight junctions and prevent gluten from infiltrating the mucosa. Phase 2 trials have shown a reduction in gastrointestinal symptoms. Phase 3 trials are expected to begin soon.3 Immunomodulation with a vaccine. This approach uses the principle of desensitisation. TIMP-GLIA (NexVax2) is a peptide based vaccine designed to reverse gluten sensitivity and stimulate immune tolerance. In phase 1 studies, vaccinated subjects showed the target T cells becoming unresponsive to antigenic stimulation with gluten challenge and a trend towards improved duodenal histology.3 Phase 2 studies are underway. Summary • Coeliac disease is a common condition in the community. However, because presentations of the disease can vary, it can be difficult to detect and many cases remain undiagnosed. • Symptoms vary from the classic gastrointestinal symptoms of diarrhoea, bloating and abdominal pain to malabsorption syndromes. Children may present with delayed growth. Complications include iron deficiency anaemia and osteoporosis. • A definitive diagnosis is important for prevention and management of complications of coeliac disease. First-degree relatives of people with coeliac disease should be tested. • Management of coeliac disease requires strict, life-long adherence to a gluten free diet. Education by a dietitian and support organisations about the importance of a gluten free diet and how to achieve this is crucial in reversing the complications of the disease. • Pharmacists can assist patients by considering the possibility of undiagnosed coeliac disease in patients with risk factors or symptoms, inquiring with diagnosed patients about how they’re managing on the gluten free diet and offering reassurance, support and information about their medications, thus enabling them to help manage their disease. Important contacts Coeliac Australia: 1300 458 836 www.coeliac.org.ai Dietitians Association of Australia: 02 6189 1200 or 1800 812 942 www.daa.asn.au References 1. Gastroenterology Expert Group, Gastroenterology version 6. In eTG complete. Melbourne. Therapeutic Guidelines; 2015. 2. ‘Coeliac disease’. BMJ Best Practice. 2018. BMJ Publishing Group. London 3. Yoosuf S, Makharia G. ‘Evolving therapy for coeliac disease’. Frontiers in Paediatrics, May 2019; Vol 7. 4. ‘Coeliac disease: recognition, assessment and management’. NICE (National Institute for Health and Care Excellence) Guideline. 2015. At: www.nice.org.uk 5. Schuppan D, Dieterich W. ‘Pathogenesis, epidemiology and clinical manifestations of coeliac disease in adults’. UpToDate, 2018. At: www.uptodate.com. 6. Tye-Din J. ‘Interpreting tests for coeliac disease’. Australian Journal of General Practice, 2018; 47 (1-2). 7. CoeliacAustraliabrochure.At:www.coeliac.org.au 8. Dietitians Association of Australia. ‘FODMAPs and IBS: what’s the deal?’ At: daa.asn.au 9. Hill I. ‘Management of coeliac disease in children’. UpToDate, 2019. At: www.uptodate.com CPD Accreditation Number: A2007RP2 (exp: 30/06/2022) This activity has been accredited for one hour of Group One CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to one hour of Group Two CPD (or 2 CPD credits) upon successful completion of relevant assessment activities. 1. Which patient group has the highest risk of developing coeliac disease? A) People with Down syndrome. B) People with a positive family history of coeliac disease. C) People with selective IgA deficiency. D) People with diabetes. 2. What is a diagnosis of coeliac disease based on? A) Gastrointestinal symptoms. B) Serological testing for tTG-IgA and DGP-IgG antibodies. C) Small bowel biopsy. D) Serological testing for tTG-IgA and DGP-IgG antibodies and small bowel biopsy. 3. People who are sensitive to FODMAPs are most likely experiencing: A) Lactose sensitivity. B) Nut sensitivity. C) Coeliac disease. D) Non-coeliac gluten sensitivity. 4. Which of the following statements about the symptoms of coeliac disease is INCORRECT? A) The classic gastrointestinal symptoms of coeliac disease include diarrhoea, constipation, abdominal bloating and pain, and flatulence. B) The most common clinical presentation of coeliac disease in adults is gastrointestinal in nature. C) Atypical presentations of coeliac disease include skin rash, osteoporosis, fatigue, and infertility. D) Symptoms of coeliac disease can be mild and up to 75 per cent of adults with coeliac disease are undiagnosed. 5. Sue has recently been diagnosed with coeliac disease. She has an appointment to see a dietitian but wants to know as much about the treatment of the disease before then. Which of the following statements is INCORRECT? A) Current management of coeliac disease involves life-long adherence to a gluten free diet. B) According to the Australian classification, gluten containing grains are wheat, rye, barley, and oats. C) Expert dietary advice is important as a gluten free diet can be low in fibre and some nutrients, and high in carbohydrates and saturated fats. D) Sue will start to feel better when she adopts a gluten free diet, and as her intestine starts to heal, she can slowly reintroduce gluten containing grains. CPD ACTIVITY 73 Coeliac disease 2 CPD CREDITS RETAIL PHARMACY • JUL 2020