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Coeliac disease — MCCQE Part 1 MCQ

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HardDiarrheaCoeliac diseaseMCCQE Part 1

A 28-year-old woman has chronic diarrhoea, bloating, weight loss and iron deficiency. IgA tissue transglutaminase is positive and total IgA is normal. Which of the following is the most appropriate next step?

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Correct answer: E — Refer for confirmatory duodenal biopsy while she continues eating gluten

Positive tTG-IgA with compatible symptoms suggests coeliac disease, but adults generally need confirmatory duodenal biopsy while still consuming gluten. Starting a gluten-free diet before biopsy can normalize findings and obscure diagnosis. IBS is a diagnosis of exclusion when malabsorption and iron deficiency are absent.

Reference: Canadian Celiac Association clinical resources; Canadian gastroenterology practice