Celiac Disease

A 35-year-old man with a 5-year history of treated celiac disease (on strict gluten-free diet for 3 years) presents with persistent diarrhea, weight loss, and abdominal pain despite excellent dietary adherence confirmed by his dietitian. Repeat tissue transglutaminase (tTG) IgA antibodies remain elevated at 38 U/mL. Upper endoscopy shows flattened duodenal mucosa with increased intraepithelial lymphocytes (>40 per 100 epithelial cells). What is the most likely diagnosis?

A 28-year-old woman from North India presents with a 2-year history of chronic diarrhea, abdominal bloating, and weight loss of 8 kg. She reports fatigue and occasional mouth ulcers. On examination, she has pallor and mild abdominal distension. Laboratory investigations show hemoglobin 9.2 g/dL, mean corpuscular volume 72 fL, serum iron 35 µg/dL, and ferritin 12 ng/mL. Tissue transglutaminase (tTG) IgA antibodies are positive at 45 U/mL (normal <15). Upper endoscopy with duodenal biopsy shows villous atrophy with increased intraepithelial lymphocytes. What is the most appropriate next step in management?

A 34-year-old woman presents with a 2-year history of recurrent dermatitis herpetiformis (intensely pruritic vesicular rash on extensor surfaces) and chronic diarrhea. Serum tissue transglutaminase (tTG) IgA is 120 U/mL, and endomysial antibodies (EMA) are positive. Upper endoscopy shows villous atrophy consistent with celiac disease. She is counseled on a gluten-free diet but admits poor adherence due to social and occupational constraints. After 6 months on an inconsistent gluten-free diet, she continues to have active dermatitis herpetiformis and persistent diarrhea. What is the most appropriate pharmacological adjunct to dietary management?

Which HLA allele is MOST strongly associated with celiac disease?

Which antibody is the MOST sensitive and specific serological marker for untreated celiac disease?