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Irritable bowel syndrome — ESEGH MCQ

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HardLuminal GIIrritable bowel syndromeESEGH

A patient has persistent malabsorption and villous atrophy after 14 months of a dietitian-confirmed strict gluten-free diet, with alternative causes excluded. Duodenal flow cytometry shows 28% surface-CD3-negative, cytoplasmic-CD3-positive intraepithelial lymphocytes lacking surface CD8. How should this be classified?

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Correct answer: D — Refractory coeliac disease type 2

Option D is correct because the clinical definition of refractory coeliac disease is met and at least 20% surface-CD3-negative, cytoplasmic-CD3-positive aberrant intraepithelial lymphocytes by flow cytometry supports type 2 disease. Option B retains a conventional intraepithelial phenotype. Option E contradicts the established coeliac history and aberrant population. Option C requires evidence of overt lymphoma rather than a premalignant aberrant clone alone. Option A is a separate cause of villous atrophy and would not explain this characteristic phenotype.

Reference: BSG guideline on adult coeliac disease 2026. https://www.bsg.org.uk/getmedia/8afda1f3-e241-4caf-ba76-cfb5fb87c558/gutjnl-2025-337747.pdf