Chronic Bloating with Nutritional Deficiency

🗒️ Question

A 34 year old woman presents with a 6-month history of bloating, diarrhoea, and weight loss. She reports fatigue and occasional abdominal pain. She has no history of recent travel or antibiotic use.

On examination, her blood pressure is 110/70 mmHg and her heart rate is 82 bpm and regular. She appears pale. There is no abdominal tenderness, and her bowel sounds are normal.

Investigations

• Haemoglobin: 10.2 g/dL (115–150)

• Mean corpuscular volume: (MCV) 75 fL (80–96)

• Serum ferritin: 7 µg/L (15–150)

• Anti-tTG antibodies: Positive

• Duodenal biopsy: Villous atrophy, increased intraepithelial lymphocytes, crypt hyperplasia

What is the most likely diagnosis?

(A) Crohn's disease

(B) Irritable bowel syndrome

(C) Lactose intolerance

(D) Coeliac disease

(E) Ulcerative colitis