A 14 year old boy presents with chronic diarrhea. Duodenal biopsy shows villous atrophy. Anti endomysial antibodies and IgA TTG antibodies are positive. What is the treatment of choice?
**Core Concept**
The patient's presentation of chronic diarrhea and villous atrophy on duodenal biopsy, along with positive anti-endomysial antibodies and IgA tissue transglutaminase (TTG) antibodies, is indicative of celiac disease, a chronic autoimmune disorder triggered by gluten consumption.
**Why the Correct Answer is Right**
The presence of these antibodies indicates an immune-mediated response against gluten, leading to intestinal damage and villous atrophy. Treatment involves strict adherence to a gluten-free diet, which alleviates symptoms, promotes healing of the intestinal mucosa, and prevents complications. This dietary modification is the cornerstone of management in celiac disease.
**Why Each Wrong Option is Incorrect**
**Option A:** Corticosteroids are not the primary treatment for celiac disease, as they do not address the underlying immune-mediated response to gluten.
**Option B:** Budesonide, a topical corticosteroid, may be used in some cases of celiac disease, but it is not the first-line treatment and is typically reserved for patients with refractory disease or those who cannot adhere to a gluten-free diet.
**Option C:** Proton pump inhibitors (PPIs) may be used to manage symptoms of celiac disease, such as abdominal pain and diarrhea, but they do not treat the underlying cause of the disease.
**Option D:** Azathioprine, an immunosuppressive medication, may be used in some cases of celiac disease, particularly in patients with refractory disease, but it is not the primary treatment and carries significant side effects.
**Clinical Pearl / High-Yield Fact**
It's essential to note that a gluten-free diet must be strictly adhered to for life, as even small amounts of gluten can trigger symptoms and exacerbate intestinal damage.
**Correct Answer:** D.