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Refractory coeliac disease — ESEGH MCQ

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HardLuminal GIRefractory coeliac diseaseESEGH

A 62-year-old woman with biopsy-proven coeliac disease remains anaemic and has diarrhoea after 18 months on a gluten-free diet. Dietetic review suggests excellent adherence. Repeat duodenal biopsy shows persistent villous atrophy and aberrant intraepithelial lymphocytes. CT enterography shows jejunal wall thickening. What is the most likely diagnosis?

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Correct answer: E — Refractory coeliac disease type II

The best answer is “Refractory coeliac disease type II”. Refractory coeliac disease type II The alternatives “Lactose intolerance after mucosal healing”, “Microscopic colitis, after multidisciplinary assessment”, “Simple inadvertent gluten exposure”, “Irritable bowel syndrome” are plausible in related gastroenterology presentations but do not match the defining finding, threshold, sequence or UK pathway in this stem.

Reference: NICE NG20 coeliac disease recommendations: https://www.nice.org.uk/guidance/ng20/chapter/Recommendations