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Coeliac disease — MCCQE Part 1 MCQ

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ModerateDiarrheaCoeliac diseaseMCCQE Part 1

A 27-year-old woman presents with chronic bloating, loose stools and fatigue. Haemoglobin is 102 g/L with low ferritin, and she has an itchy blistering rash over the elbows. She eats gluten daily. What is the most appropriate investigation?

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Correct answer: A — Tissue transglutaminase IgA with total IgA level

Chronic diarrhoea, iron deficiency and dermatitis herpetiformis suggest coeliac disease, and tTG-IgA with total IgA is an appropriate initial test while the patient is eating gluten. Starting a gluten-free diet before testing can produce false-negative results. Colonoscopy may be needed for other red flags, but serology is the targeted first investigation here.

Reference: https://mcc.ca/objectives/medical-experts/