A 48-year-old woman presents with a 2-month history of change in bowel habit and 10-lb weight loss despite preservation of appetite. She notices increased abdominal gas, particularly after fatty meals. The stools are malodorous and occur two to three times per day; no rectal bleeding is noticed. The symptoms are less prominent when she follows a clear liquid diet.
Which of the following is the most likely histological abnormality associated with this patient’s symptoms?
A. Signet ring cells on gastric biopsyThe patient’s history suggests malabsorption. Weight loss despite increased appetite goes with either a hypermetabolic state (such as hyperthyroidism) or nutrient malabsorption. The gastrointestinal symptoms support the diagnosis of malabsorption. Patients may notice greasy malodorous stools, increase in stool frequency, stools that are tenacious and difficult to flush, as well as changes in bowel habit according to the fat content of the diet. In the United States, celiac sprue (gluten-sensitive enteropathy) and chronic pancreatic insufficiency are the commonest causes of malabsorption. The histological pattern described in option c is associated with celiac sprue. IgA antiendomysial antibodies and antibodies against tissue transglutaminase provide supporting evidence. Signet ring cells are seen with gastric cancer. This lesion causes weight loss through anorexia or early satiety but would not cause malabsorption. Colonic mucosal inflammation and crypt abscesses are associated with ulcerative colitis; since this disease affects only the colon, small bowel absorption is not affected. Helicobacter pylori (which appears as curved gram-negative rods on gastric biopsy) is not associated with malabsorption. Periportal inflammation is seen in chronic hepatitis but does not cause malabsorption.