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Coeliac disease — ESEGH MCQ

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EasyLuminal GICoeliac diseaseESEGH

A 34-year-old woman has iron deficiency anaemia, bloating and loose stools. She has been eating gluten daily. Tissue transglutaminase IgA is strongly positive and total IgA is normal. Oesophagogastroduodenoscopy shows scalloping in the second part of the duodenum. What is the most appropriate management?

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Correct answer: B — Take duodenal biopsies before starting a gluten-free diet

Positive serology while eating gluten and endoscopic features suggest coeliac disease, but adult diagnosis is generally confirmed with duodenal biopsies before gluten withdrawal. Starting a gluten-free diet before biopsy can normalise histology and obscure diagnosis. Colonoscopy does not confirm coeliac disease. The teaching point is to keep patients on gluten until diagnostic testing is complete.

Reference: BSG Adult Coeliac Disease Guideline