A middle-aged woman presented with loose stool and weight loss. Initially, she refused an endoscopy and a diagnosis of coeliac disease was made on the basis of a high tissue transglutaminase (tTG) antibody titre. She was started on a gluten-free diet (GFD) but her symptoms remained despite adherence to the GFD. After several months she agreed to undergo an endoscopy. The images show the endoscopic view of the duodenal mucosa (figure 1) and the corresponding histology slide (figure 2) stained with haemotoxylin and eosin (H&E).
WHAT WOULD YOU DO NEXT?
a) Refer the patient for a dietary review
b) Request a clonal analysis of the intraepithelial lymphocytes
c) Refer for HLA DQ2/DQ8 testing
d) Refer the patient for capsule endoscopy
e) Add prednisolone to the dietary restrictions