A 45-year-old woman presents with fat malabsorption, osteoporosis, and a skin biopsy showing IgA deposits at the dermal-epidermal junction. Serology reveals anti-tissue transglutaminase IgA elevated. She denies GI symptoms. Duodenal biopsy shows Marsh 3b changes (marked villous blunting with crypt hyperplasia). The most important dietary intervention is:
- A Low-fat diet only
- B Lactose-free diet temporarily
- C Strict gluten-free diet for life ✓
- D High-fiber diet to improve intestinal absorption
Explanation
This presentation is classic celiac disease with dermatitis herpetiformis (IgA deposition at dermo-epidermal junction, pathognomonic). Celiac disease is triggered by dietary gluten (gliadin fraction of wheat, rye, barley); strict lifelong gluten-free diet is the cornerstone and only proven treatment. Marsh 3 lesions (villous atrophy) reverse with gluten-free diet over months to years. Secondary lactose intolerance is common due to reduced lactase activity and may require temporary lactose restriction, but this is not the primary intervention. Failure to adhere to a gluten-free diet risks refractory celiac disease, enteropathy-associated T-cell lymphoma (EATL), and ongoing bone disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.