ROSH Gastrointestinal Practice Exam

Which condition is associated with iron deficiency anemia and elevated stool osmotic gap?

1. Cholecystitis

2. Celiac disease

3. Peptic ulcer disease

4. Gastroesophageal reflux disease

The correct answer is: Celiac disease

Celiac disease is commonly associated with iron deficiency anemia due to malabsorption of nutrients in the small intestine. In individuals with this autoimmune disorder, the ingestion of gluten—a protein found in wheat, barley, and rye—triggers an immune response that damages the intestinal lining. This damage leads to malabsorption of not only gluten but also other essential nutrients, including iron, resulting in iron deficiency anemia. Additionally, celiac disease can lead to an elevated stool osmotic gap, a measurement used to assess the type of diarrhea present. Diarrhea related to malabsorption—like that seen in celiac disease—often has a high osmotic gap due to the presence of unabsorbed nutrients in the intestines. This unabsorbed material draws water into the bowel, leading to watery stools, thus increasing the osmotic gap. In contrast, conditions like cholecystitis, peptic ulcer disease, and gastroesophageal reflux disease do not typically result in significant malabsorption that would lead to iron deficiency anemia or changes in the stool osmotic gap in the same manner as celiac disease. Cholecystitis primarily involves inflammation of the gallbladder often leading to digestive issues due to bile salt malabsorption, while