Gastroenterology
Case 31: A Woman with Extreme Fatigue and Weight Loss
CASE
A 42‐year‐old woman is referred for investigation. She reported extreme fatigue to her GP who has become concerned that she might have malabsorption. She has a reasonable appetite but on reflection she feels that she has lost 6 kg in weight over the previous year. She experiences some postprandial abdominal bloating and has noticed an increase in her bowel frequency now going 2–3 times per day passing a loose stool that often floats in the toilet. She has had multiple mouth ulcers and has recently developed an itchy blistering rash on her elbows and buttocks. She has been taking ferrous sulphate. She has no family history of gastrointestinal disease. Examination is unremarkable.
Blood tests showed:
Hb 11.2 g/dL WCC 3.4 × 109/L Platelets 250 × 109/L Na 138 mmol/L K 3.9 mmol/L Urea 3.4 mmol/L Creatinine 110 µmol/L Albumin 30 g/L Bilirubin 12 µmol/L ALP 146 U/L ALT 78 U/L
QUESTION 1
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The best serological test to screen for coeliac disease would be: