A 60-year-old man presented with abdominal pain. He had coeliac serology performed while on a gluten containing diet: immunoglobulin A – tissue transglutaminase antibodies (IgA-tTG) 128 U/mL (normal range 0–7) and total serum IgA 2.3 g/L (normal range 0.8–3.0). Which would be the next appropriate step in management? (a) Commence a lifelong gluten free diet. (b) Perform human leukocyte antigen (HLA) typing. (c) Perform IgA – anti-endomysial antibodies (EMA). (d) Perform IgG-EMA. (e) Refer for gastroscopy. 2. A 25-year-old woman presented to secondary care with symptoms of a ‘foggy mind’ a few hours after consuming gluten. She self-imposed a gluten free diet for the previous.
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