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Type 3c diabetes — ESEGH MCQ

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HardPancreatico-biliary DiseaseType 3c diabetesESEGH

Coeliac disease was biopsy-confirmed three years ago. Diarrhoea and weight loss persist despite expert dietetic confirmation of strict gluten exclusion; repeat evaluation excludes infection, pancreatic insufficiency, microscopic colitis and small-bowel bacterial overgrowth. What is the next classification and action?

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Correct answer: C — Arrange specialist referral for suspected refractory coeliac disease

Explanation lettering: B = shown as A · C = shown as B · A = shown as C

A is correct. NICE defines refractory coeliac disease only after confirming the original diagnosis and excluding gluten exposure and coexisting causes, then recommends specialist-centre referral. B is premature after objective malabsorptive features. C intentionally reintroduces the trigger. D does not invalidate the original histology. E precedes specialist classification and ignores important subtype and lymphoma assessment.

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