Gastroenterology: coeliac disease diagnosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Gastroenterology: coeliac disease diagnosis

Sample item

A 30-year-old woman from Punjab with iron deficiency anaemia, bloating and loose stools began a strict gluten-free diet on her own six months ago and feels better. Serum anti-tissue transglutaminase IgA is negative and total IgA is normal. She wants a definitive answer. What is the best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Reintroduce gluten for several weeks, then repeat serology and take duodenal biopsies

Antibody titres fall and villous atrophy heals on a gluten-free diet, so tests done on treatment are falsely negative. The diagnosis requires testing during adequate gluten intake (about 2 slices of bread daily for 6 to 8 weeks) with serology and duodenal biopsy. HLA-DQ2 or DQ8 is common in the general population, so a positive result does not confirm disease.

Option by option

  • A. Reintroduce gluten for several weeks, then repeat serology and take duodenal biopsies (correct)

    Correct. Testing on a gluten challenge removes the false negative caused by the diet.

  • B. Confirm the diagnosis by finding HLA-DQ2 in her blood

    Many healthy people carry HLA-DQ2 or DQ8, so a positive typing has little diagnostic value; only a negative result helps to exclude disease.

  • C. Perform small bowel capsule endoscopy while she continues the diet

    Capsule endoscopy cannot give histology and is not used to diagnose coeliac disease in a patient on treatment.

  • D. Conclude that coeliac disease is excluded because serology is negative

    A negative result on a gluten-free diet does not exclude disease, because antibodies decline with treatment.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Reintroduce gluten for several weeks, then repeat serology and take duodenal biopsies. Antibody titres fall and villous atrophy heals on a gluten-free diet, so tests done on treatment are falsely negative.

Why is "Confirm the diagnosis by finding HLA-DQ2 in her blood" not the answer?

Many healthy people carry HLA-DQ2 or DQ8, so a positive typing has little diagnostic value; only a negative result helps to exclude disease.

Why is "Perform small bowel capsule endoscopy while she continues the diet" not the answer?

Capsule endoscopy cannot give histology and is not used to diagnose coeliac disease in a patient on treatment.

Why is "Conclude that coeliac disease is excluded because serology is negative" not the answer?

A negative result on a gluten-free diet does not exclude disease, because antibodies decline with treatment.

What concept does this question test?

It tests Gastroenterology: coeliac disease diagnosis in General Medicine. The diagnosis requires testing during adequate gluten intake (about 2 slices of bread daily for 6 to 8 weeks) with serology and duodenal biopsy. HLA-DQ2 or DQ8 is common in the general population, so a positive result does not confirm disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: coeliac disease diagnosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.