A female patient is having diarrhea and abdominal distension. Small intestinal biopsy shows villous at rophy and crypt hyperplasia. Diagnosis is-

adults, celiac disease manifests most commonly between the ages of 30 and 60. Some patients have silent celiac disease, defined as positive serology and villous atrophy without symptoms, or latent celiac disease, in which positive serology is not accompanied by villous atrophy. Symptomatic adult celiac disease is often associated with anemia (due to iron deficiency and, less commonly, B12 and folate deficiency), diarrhea, bloating, and fatigue. Pediatric celiac disease, which affects male and female children equally, may manifest with classic symptoms, typically between the ages of 6 and 24 months (after introduction of gluten to the diet) with irritability, abdominal distention, anorexia, diarrhea, failure to thrive, weight loss, or muscle wasting. Children with nonclassic symptoms tend to present at older ages with complaints of abdominal pain, nausea, vomiting, bloating, or constipation. A characteristic pruritic, blistering skin lesion, dermatitis herpetiformis, also is present in as many as 10% of patients TEXT BOOK OF ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE.579 IMAGE REFERENCE: