A 37-year-old woman has chronic bloating, diarrhea, and iron deficiency anemia. Tissue transglutaminase IgA is positive and total IgA is normal. She

Question

A 37-year-old woman has chronic bloating, diarrhea, and iron deficiency anemia. Tissue transglutaminase IgA is positive and total IgA is normal. She has been eating gluten and has not started dietary changes. Which of the following is the most appropriate next step in management?

Accepted Answer

Confirm diagnosis with upper endoscopy and duodenal biopsy

Answer

Start chronic antibiotics for bacterial overgrowth

Answer

Treat with pancreatic enzymes without testing

Answer

Start a gluten-free diet before diagnostic testing

Answer

Order colonoscopy as the diagnostic gold standard

Celiac disease — USMLE Step 3 MCQ

A 37-year-old woman has chronic bloating, diarrhea, and iron deficiency anemia. Tissue transglutaminase IgA is positive and total IgA is normal. She has been eating gluten and has not started dietary changes. Which of the following is the most appropriate next step in management?