A 20 year old woman presents to her GP with 2 months of diffuse abdominal pain and distension. This is particularly marked after eating. She has also noticed considerable weight loss and an itchy rash across her torso.

The woman also complains of particularly foul-smelling faeces over the past few months. Her only past medical history is type 1 diabetes mellitus. She denies ever drinking alcohol or smoking.

Her GP decides to arrange for blood testing, with one of the results coming back strongly positive for serum IgA Anti-tissue Transglutaminase (anti-TTG). A pregnancy test is negative.

Which of the following is the most likely underlying diagnosis?

Options:
explanation: This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. Although lactose intolerance is also associated with diffuse abdominal pain with distension, changes in bowel habits and weight loss, the presence of dermatitis herpetiformis and IgA anti-TTG indicates coeliac disease is a more likely underlying diagnosis.
name: Lactose intolerance
label: c
answer: no
explanation: This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. This in turn leads to small bowel damage and symptoms of malabsorption; including diffuse abdominal pain, distension, steatorrhea, weight loss and dermatitis herpetiformis. IgA anti-TTG is a strong biomarker for coeliac disease, further supporting this diagnosis. Treatment involves lifelong avoidance of gluten.
name: Coeliac disease
label: a
answer: yes
explanation: This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. Although colorectal cancer is also associated with changes in bowel habits and weight loss, the presence of dermatitis herpetiformis and IgA anti-TTG indicate coeliac disease is a more likely underlying diagnosis. Furthermore, colorectal cancer does not typically cause pain except in the case of an acute bowel obstruction and is rare in a young patient.
name: Colorectal cancer
label: d
answer: no
explanation: This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. Chronic pancreatitis is associated with epigastric rather than diffuse abdominal pain, and is most commonly caused by long-term alcohol overuse. The presence of IgA anti-TTG antibodies also indicates coeliac disease is a more likely underlying diagnosis than chronic pancreatitis.
name: Chronic pancreatitis
label: e
answer: no
explanation: This is a classic presentation of coeliac disease. Coeliac disease is a T cell-mediated autoimmune condition characterised by the body's inflammatory response to dietary gluten. Although Crohn's disease is also associated with diffuse abdominal pain with distension, changes in bowel habits and weight loss, the presence of dermatitis herpetiformis and IgA anti-TTG indicates coeliac disease is a more likely underlying diagnosis.
name: Crohn's
label: b
answer: no

Correct answer: a