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Coeliac disease — RACP Paediatrics MCQ

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EasyGICoeliac diseaseRACP Paediatrics

A 3-year-old presents with faltering growth, abdominal distension, loose pale stools, and irritability over 6 months. The child was growing well until complementary feeds were introduced at 6 months. What is the most appropriate initial investigation?

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Correct answer: A — Tissue transglutaminase (tTG) IgA + total IgA

The presentation of failure to thrive with GI symptoms following gluten introduction is highly suggestive of coeliac disease. Tissue transglutaminase IgA with total IgA level is the recommended first-line screening test. Total IgA is needed to exclude IgA deficiency which would cause a false-negative tTG result.

Reference: RCH Melbourne – 2023 – Coeliac Disease CPG; Australian Therapeutic Guidelines – 2024 – GI