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Coeliac Disease — RACP Paediatrics MCQ

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ModerateGastroenterologyCoeliac DiseaseRACP Paediatrics

A 2-year-old child presents with chronic diarrhoea, abdominal distension, and poor weight gain. She has been on a normal diet including wheat-based cereals since 6 months of age. Her IgA tissue transglutaminase (tTG) antibody titre is >100 U/mL (normal <7 U/mL) and total IgA is normal. What is the next most appropriate step?

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Correct answer: B — Refer for small bowel biopsy to confirm the diagnosis

While ESPGHAN 2020 guidelines allow a no-biopsy pathway in symptomatic children with tTG >10x upper limit of normal and positive endomysial antibodies (EMA) on a separate sample, the Australasian Society for Paediatric Gastroenterology (AUSPGHAN) still generally recommends confirmatory small bowel biopsy. Biopsy confirms villous atrophy (Marsh 3) and provides definitive diagnosis before committing to lifelong dietary change.

Reference: AUSPGHAN – 2024 – Position Statement on Diagnosis of Coeliac Disease in Children