A 50-year-old man has chronic diarrhoea with steatorrhoea, weight loss, and a serum D-xylose absorption test showing 1.8 g excreted in urine in 5 hours after a 25 g oral dose (normal >4 g). Small bowel biopsy shows subtotal villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Serology reveals anti-tissue transglutaminase IgA > 10× ULN. The MOST appropriate dietary intervention is:
- A Low-fat diet
- B Lactose-free diet only
- C Strict gluten-free diet (avoiding wheat, barley, rye) for life ✓
- D Elemental diet for 6 weeks then re-introduce gluten
Correct answer: C. Strict gluten-free diet (avoiding wheat, barley, rye) for life
Explanation
This presentation is classic coeliac disease (gluten-sensitive enteropathy): subtotal villous atrophy, elevated anti-tTG IgA (>10× ULN is diagnostic without biopsy in children per ESPGHAN, and strongly supportive in adults), and malabsorption with positive D-xylose test indicating small bowel mucosal disease. The only proven treatment is a strict, lifelong gluten-free diet eliminating all sources of wheat, barley, and rye. Even trace gluten exposure perpetuates intestinal damage. Non-adherence risks refractory coeliac disease and T-cell lymphoma.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.