American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition can lead to increased risk for celiac disease in patients with diarrhea-predominant IBS?

1. Chronic pancreatitis

2. Type 2 diabetes

3. Celiac disease

4. Irritable bowel syndrome

The correct answer is: Celiac disease

Increased risk for celiac disease in patients with diarrhea-predominant irritable bowel syndrome (IBS) can be attributed to the potential for misdiagnosis and overlapping symptoms between the two conditions. Celiac disease is an autoimmune disorder that occurs in genetically predisposed individuals, characterized by an adverse reaction to gluten, which can manifest with gastrointestinal symptoms similar to those seen in IBS, notably diarrhea. Patients with diarrhea-predominant IBS may present with a variety of symptoms such as bloating, abdominal pain, and frequent diarrhea, which can overshadow the specific symptoms of celiac disease. This overlap can cause clinicians to overlook the possibility of celiac disease, leading to a delay in diagnosis. Furthermore, studies have suggested that there is an increased prevalence of celiac disease in patients initially diagnosed with IBS, particularly those with predominant diarrhea. Recognizing celiac disease in these patients is crucial, as it requires a completely different management approach, primarily involving a strict gluten-free diet. If celiac disease remains undiagnosed, the patient may continue to experience significant gastrointestinal distress and potential long-term complications such as malnutrition and increased risk of intestinal lymphoma. In contrast, the other conditions listed do not have a direct association with an increased risk for celiac