A 28-year-old woman presents to her primary care physician with 8 months of chronic diarrhea, abdominal bloating, and fatigue. She reports a 12-pound unintentional weight loss during this period. Her medical history is significant for autoimmune thyroid disease treated with levothyroxine. Temperature is 36.9°C (98.4°F), blood pressure is 112/70 mm Hg, pulse is 88/min, and respiratory rate is 14/min. Physical examination reveals mild abdominal distention without tenderness to palpation. Laboratory studies demonstrate a hemoglobin level of 10.2 g/dL, mean corpuscular volume of 72 μm³, and ferritin level of 8 ng/mL. Serologic testing is positive for anti-tissue transglutaminase IgA antibodies.
Which of the following findings is most likely to be seen on small bowel biopsy?
The correct answer is:
A: Crypt hyperplasia with villous atrophy.
This patient has celiac disease, as evidenced by chronic diarrhea, weight loss, iron deficiency anemia, autoimmune thyroid disease, and positive anti-tissue transglutaminase antibodies. Small bowel biopsy classically demonstrates villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. These histologic changes impair nutrient absorption and explain the patient’s malabsorptive symptoms.
Answer choice B: Diffuse transmural inflammation, is incorrect.
Transmural inflammation is characteristic of Crohn disease rather than celiac disease. Crohn disease often presents with skip lesions, fistulas, and perianal disease.
Answer choice C: Granulomatous inflammation, is incorrect.
Granulomas are a classic histologic finding in Crohn disease. This answer would be more appropriate in a patient with inflammatory bowel disease involving multiple segments of the gastrointestinal tract.
Answer choice D: Mucosal pseudopolyps, is incorrect.
Pseudopolyps result from repeated cycles of mucosal injury and healing and are commonly associated with ulcerative colitis. They are not seen in celiac disease.
Answer choice E: Noncaseating granulomas of the colon, is incorrect.
Noncaseating granulomas are most strongly associated with Crohn disease rather than celiac disease. The patient’s positive serology and iron deficiency anemia support a malabsorptive disorder instead.
Key Learning Point
Celiac disease is characterized by villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes on small bowel biopsy.
