ROSH Gastrointestinal Practice Exam

In a patient with a 3-week history of diarrhea and a skin rash, which diagnosis is most likely indicated by the presence of anti-endomysial antibodies?

1. Celiac disease

2. Crohn disease

3. Diverticular disease

4. Ulcerative colitis

The correct answer is: Celiac disease

The presence of anti-endomysial antibodies is most notably associated with celiac disease, an autoimmune disorder triggered by the ingestion of gluten in genetically predisposed individuals. In celiac disease, the immune response damages the lining of the small intestine, leading to malabsorption and a range of gastrointestinal symptoms, including diarrhea. The co-occurrence of a skin rash is also characteristic, particularly dermatitis herpetiformis, which is a papular rash observed in some patients with celiac disease. Other conditions, while having overlapping symptoms, do not typically present with anti-endomysial antibodies. For instance, Crohn disease and ulcerative colitis are types of inflammatory bowel disease (IBD) that primarily involve inflammation in the gastrointestinal tract but are not associated with a specific antibody response like that seen in celiac disease. Diverticular disease, on the other hand, involves the presence of diverticula in the colon and does not typically present with the immune response indicated by anti-endomysial antibodies. Therefore, the diagnosis indicated by the presence of these antibodies points clearly to celiac disease.