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Coeliac disease — MCCQE Part 1 MCQ

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ModerateDiarrheaCoeliac diseaseMCCQE Part 1

A 15-month-old girl has failure to thrive, chronic diarrhoea, and abdominal distension since starting wheat-based cereals. Falling growth centiles. Anti-tTG IgA strongly positive with normal total IgA. Most appropriate next step?

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Correct answer: E — Refer for upper endoscopy with duodenal biopsies

Strongly positive anti-tTG + symptoms: confirmatory duodenal biopsies recommended in Canadian practice. Patient must remain on gluten-containing diet until biopsies obtained — GFD before biopsy can normalise histology.

Reference: CPS / Canadian Celiac Association