After this activity, the participant will be able to understand the diagnostic approach to celiac disease (CD) in patients as well as the monitoring of patients with CD.
A 32-year-old woman with autoimmune thyroiditis presents with a 5-year history of intermittent diarrhea and bloating. Her only medication is levothyroxine 50 μg daily. Four months ago, she decided to go on a strict gluten free diet (GFD) and her symptoms improved with resolution of bloating and diarrhea. While on GFD, her immunoglobulin A (IgA) tissue transglutaminase (TTG) antibody test was negative and serum IgA level was normal. She is reluctant to undergo a formal gluten challenge.
Which of the following is the next best step?
- A. Perform HLA-DQ2/DQ8 genotyping
- B. Obtain duodenal biopsies
- C. Get a D-xylose test
- D. Order immunoglobulin G (IgG)-deamidated gliadin peptides (DGPs)
A 19-year-old man with CD presents to the clinic for a follow-up. He was diagnosed with CD 4 months ago and had a complete resolution of diarrhea and bloating after starting a GFD. He recently moved into his college dorm and continues to be on GFD, but has noticed a recurrence of mild diarrhea.
Which of the following should you order next?
- A. Serology (IgA TTG or IgA [or IgG] DGP antibodies)
- B. Upper endoscopy with intestinal biopsies
- C. Dietitian consult
- D. Stool studies
In a patient with selective IgA deficiency who is on a normal diet, what is the recommended initial test for the detection of celiac disease?
- A. HLA-DQ2/DQ8 testing
- B. IgG-based testing
- C. Antibodies directed against native gliadin
- D. Upper endoscopy with duodenal biopsies