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Exam 1: Celiac Disease: Ten Things that Every Gastroenterologist Should Know
Clinical Gastroenterology and Hepatology 2015;13:e127–e129
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES CME Credits: The AGA Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)Ô. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any relevant financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant articles and taking these CME examinations online at http://www. cghjournal.org/content/cme. Answers can be obtained online after completing the exam(s).
Objectives: See article for specific learning objective.
e128 CME Activity
Clinical Gastroenterology and Hepatology Vol. 13, No. 8
Exam 1: Celiac Disease: Ten Things that Every Gastroenterologist Should Know Test ID No.: 0224
Contact Hours: 1.0
Expiration Date: August 31, 2016
Question 1: A 42-year-old woman presents to the clinic with newonset bloating and increased stool frequency for the past 6 months. She is otherwise healthy, is on no medications, and has no pertinent family history. She is currently consuming a gluten-containing diet. She asks you whether she may have celiac disease. Which of the following is the next best step?
a. b. c. d. e.
IgA IgA IgA IgA IgA
endomysial antibody tissue transglutaminase antibody and IgG tissue transglutaminase antibody deaminated gliadin peptide and IgG deaminated gliadin peptide
Question 2: A 28-year-old woman is sent to undergo an esophagogastroduodenoscopy to evaluate for celiac disease, given she was found to have a positive serologic test for celiac disease during the work-up of her diarrhea and weight loss. As the performing endoscopist, what is the best biopsy strategy?
a. Take 4 biopsies from the duodenal bulb b. Take 4 biopsies from the post-bulbar duodenum c. Take 1 biopsy each from the duodenal bulb and the post-bulbar duodenum d. Take 2 biopsies from the duodenal bulb and 4 from the post-bulbar duodenum e. Take 8 biopsies from the post-bulbar duodenum
Question 3: A mother brings her 2-year-old son who has Down’s syndrome in for a routine appointment, and requests that testing for celiac disease be considered for him given the increased likelihood of disease. He has no clinical symptoms or obvious extra-intestinal features, although he is small for age. She tells you she has kept him off gluten for the past 6 months. Which of the following is the next best step?
a. b. c. d. e.
Advise that no testing needed Immunoglobulin IgA level Human leukocyte antigen haplotyping IgA tissue transglutaminase antibody Esophagogastroduodenoscopy with duodenal biopsies
a. b. c. d. e.
Initiate intravenous iron replacement Begin oral thiamine Check serum chromium level Order electromyography Check serum copper level
Question 4: A 37-year-old woman presents for an evaluation for celiac disease, which was discovered during the work-up for iron-deficiency anemia. Celiac serology is positive and small bowel biopsies compatible with the diagnosis. She is placed on a gluten-free diet and iron replacement. She returns to for follow-up 6 months later, complaining of lower extremity weakness. Laboratory studies show a persistent microcytic anemia, with a normal serum ferritin. Her celiac serologies are improved from the time of diagnosis. Which if the following is the next best step?
August 2015
CME Activity e129
Question 5: A 51-year-old man presents to your clinic to establish care, after recently moving to the community for his job. He was diagnosed with celiac disease 9 months ago, and states he had laboratory studies and small bowel biopsies that were consistent with the diagnosis. Despite following a strict gluten-free diet ever since, he continues to note diarrhea and progressive weight loss. Laboratory studies reveal a normal IgA tissue transglutaminase antibody at this time. Which of the following is the next best step?
a. b. c. d. e.
Request outside labs and biopsies Refer him to a dietician Esophagogastroduodenoscopy with follow-up biopsies Computed tomography enterography Capsule endoscopy
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES CME Credits: The AGA Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)Ô. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any relevant financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant articles and taking these CME examinations online at http://www. cghjournal.org/content/cme. Answers can be obtained online after completing the exam(s).
Objectives: See article for specific learning objective.
e128 CME Activity
Clinical Gastroenterology and Hepatology Vol. 13, No. 8
Exam 1: Celiac Disease: Ten Things that Every Gastroenterologist Should Know Test ID No.: 0224
Contact Hours: 1.0
Expiration Date: August 31, 2016
Question 1: A 42-year-old woman presents to the clinic with newonset bloating and increased stool frequency for the past 6 months. She is otherwise healthy, is on no medications, and has no pertinent family history. She is currently consuming a gluten-containing diet. She asks you whether she may have celiac disease. Which of the following is the next best step?
a. b. c. d. e.
IgA IgA IgA IgA IgA
endomysial antibody tissue transglutaminase antibody and IgG tissue transglutaminase antibody deaminated gliadin peptide and IgG deaminated gliadin peptide
Question 2: A 28-year-old woman is sent to undergo an esophagogastroduodenoscopy to evaluate for celiac disease, given she was found to have a positive serologic test for celiac disease during the work-up of her diarrhea and weight loss. As the performing endoscopist, what is the best biopsy strategy?
a. Take 4 biopsies from the duodenal bulb b. Take 4 biopsies from the post-bulbar duodenum c. Take 1 biopsy each from the duodenal bulb and the post-bulbar duodenum d. Take 2 biopsies from the duodenal bulb and 4 from the post-bulbar duodenum e. Take 8 biopsies from the post-bulbar duodenum
Question 3: A mother brings her 2-year-old son who has Down’s syndrome in for a routine appointment, and requests that testing for celiac disease be considered for him given the increased likelihood of disease. He has no clinical symptoms or obvious extra-intestinal features, although he is small for age. She tells you she has kept him off gluten for the past 6 months. Which of the following is the next best step?
a. b. c. d. e.
Advise that no testing needed Immunoglobulin IgA level Human leukocyte antigen haplotyping IgA tissue transglutaminase antibody Esophagogastroduodenoscopy with duodenal biopsies
a. b. c. d. e.
Initiate intravenous iron replacement Begin oral thiamine Check serum chromium level Order electromyography Check serum copper level
Question 4: A 37-year-old woman presents for an evaluation for celiac disease, which was discovered during the work-up for iron-deficiency anemia. Celiac serology is positive and small bowel biopsies compatible with the diagnosis. She is placed on a gluten-free diet and iron replacement. She returns to for follow-up 6 months later, complaining of lower extremity weakness. Laboratory studies show a persistent microcytic anemia, with a normal serum ferritin. Her celiac serologies are improved from the time of diagnosis. Which if the following is the next best step?
August 2015
CME Activity e129
Question 5: A 51-year-old man presents to your clinic to establish care, after recently moving to the community for his job. He was diagnosed with celiac disease 9 months ago, and states he had laboratory studies and small bowel biopsies that were consistent with the diagnosis. Despite following a strict gluten-free diet ever since, he continues to note diarrhea and progressive weight loss. Laboratory studies reveal a normal IgA tissue transglutaminase antibody at this time. Which of the following is the next best step?
a. b. c. d. e.
Request outside labs and biopsies Refer him to a dietician Esophagogastroduodenoscopy with follow-up biopsies Computed tomography enterography Capsule endoscopy