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Celiac disease with IgA deficiency — ABIM Board MCQ

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HardGastroenterology/HepatologyCeliac disease with IgA deficiencyABIM Board

A 39-year-old woman has chronic watery diarrhea, bloating, and iron deficiency. Tissue transglutaminase IgA is negative, but total IgA is markedly low. She has no travel exposure. Which of the following is the most appropriate diagnostic study?

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Correct answer: B — IgG-based deamidated gliadin peptide or tissue transglutaminase testing

IgA deficiency can cause false-negative IgA tissue transglutaminase testing. IgG-based celiac serologies and confirmatory duodenal biopsy while consuming gluten are appropriate.

Reference: ACG Celiac Disease Guideline