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Coeliac disease — MRCPCH FOP MCQ

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ModerateGastroenterologyCoeliac diseaseMRCPCH FOP

A 7-year-old girl has abdominal bloating, loose stools and falling weight centiles. She has iron deficiency anaemia and her mother has autoimmune thyroid disease. What is the most appropriate investigation?

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Correct answer: A — Tissue transglutaminase IgA with total IgA

Symptoms, faltering growth and iron deficiency suggest coeliac disease, and serology with total IgA is the appropriate first investigation while the child remains on gluten. Starting a gluten-free diet before testing can produce false-negative results. Faecal elastase is used when pancreatic insufficiency is suspected. The pearl is to check total IgA because IgA deficiency can make IgA-based coeliac tests misleading.

Reference: NICE NG20 Coeliac disease