A 19-year-old man has a long history of weight loss, abdominal distention, bloating, and diarrhea. Investigation reveals steatorrhea, and a small bowel biopsy reveals blunting and flattening of villi.

This syndrome is likely celiac disease, but a clinical and histologic improvement with a gluten-free diet would be required for confirmation. The decrease in pancreatic enzyme production is secondary to decreased intestinal secretion of hormones that stimulate the pancreas. Dermatitis herpetiformis might be related to celiac disease. Although gross malabsorption is the classical description of celiac disease, it can present with isolated deficiencies such as iron deficiency anemia.