A 2-year-old boy presents with a 3-month history of frequent bulky, foul-smelling stools, failure to thrive, abdominal distension, and poor weight gain after the introduction of barley cereal into his diet. Serum anti-tissue transglutaminase (anti-tTG) IgA antibody is strongly positive (> 10x normal). What is the definitive dietary management?
Answer and explanation
Correct answer: A. Strict lifelong gluten-free diet
- Step 1: Clinical and serological findings indicate Celiac disease (gluten-sensitive enteropathy) triggered by ingestion of gluten proteins found in wheat, barley, and rye.
- Step 2: The only effective and essential treatment to restore normal intestinal villous architecture and promote growth is a strict lifelong gluten-free diet.
Answer
Strict lifelong gluten-free diet.
Why not the others: 'Lactose-free formula' manages secondary lactose intolerance but does not treat the autoimmune enteropathy; 'Low-FODMAP diet' is for irritable bowel syndrome; 'Ketogenic diet' treats refractory epilepsy, not celiac sprue.
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