ROSH Gastrointestinal Practice Exam

A young woman with daily diarrhea and positive anti-endomysial antibodies is most likely diagnosed with which condition?

1. Bile acid deficiency

2. Celiac disease

3. Clostridium difficile infection

4. Irritable bowel syndrome

The correct answer is: Celiac disease

The presence of positive anti-endomysial antibodies strongly indicates celiac disease, which is an autoimmune disorder triggered by the ingestion of gluten. In this condition, the ingestion of gluten leads to an inappropriate immune response that damages the small intestine's mucosal lining, resulting in malabsorption and symptoms such as diarrhea, weight loss, and various nutritional deficiencies. Celiac disease is commonly associated with other autoimmune conditions and can present with diverse gastrointestinal and extra-intestinal symptoms. The use of anti-endomysial antibodies as a marker is well-documented, as these antibodies are highly specific for celiac disease. Their presence suggests an ongoing immune reaction against the intestinal epithelium, which aligns with the patient's symptom of daily diarrhea. In contrast, other conditions listed either do not typically correlate with positive anti-endomysial antibodies or present with different clinical features. Bile acid deficiency can lead to diarrhea, but it is not associated with such antibodies. Clostridium difficile infection would generally present with a recent history of antibiotic use and specific symptoms tied to that infection. Irritable bowel syndrome is a common functional gastrointestinal disorder but lacks the autoimmune component and specific serological markers found in celiac disease. Thus, the combination of daily diarrhea and positive anti