Option D: The clinical scenario of diarrhea, steatorrhea, weight loss, and growth retardation, along with positive class II HLA-DQ2, is consistent with a diagnosis of celiac disease. Patients with celiac disease are advised to avoid gluten.

Celiac disease/celiac sprue/gluten-sensitive enteropathy is an immune-mediated disorder triggered by gluten-containing foods. The presence of one of the two locus antigens HLA-DQ2 or HLA-DQ8 is necessary, but not sufficient for the development of this condition. Detection of these is not useful for the diagnosis, however, their absence helps to exclude celiac disease.
The pathogenesis involves an inflammatory response to gluten and gliadin (gluten-derived peptide). In the small intestine, gliadin is deamidated by the tissue transglutaminase (tTG), an intestinal enzyme. The deamidated gliadin is more immunogenic and is presented to helper T cells, which mediate mucosal inflammation and cause tissue damage.
Children usually present with diarrhea, weight loss, and growth failure. Other features include malabsorption, bloating, irregular bowel habits, iron deficiency anemia, osteoporosis, ataxia, and abnormal liver enzymes.
Screening for celiac disease is done by testing for serum antibodies, including tissue transglutaminase IgA, anti-endomysial, and deamidated antigliadin antibodies. The diagnosis in patients with positive antibodies is confirmed by biopsy of the second part of the duodenum or proximal jejunum. Microscopic findings of biopsy show intraepithelial CD8+ lymphocytes, villous atrophy, and crypt hyperplasia.

Other options:

Option A: A fat-free diet is advised for various disorders causing steatorrhea. These include pancreatic insufficiency, cystic fibrosis, and familial hypercholesterolemia.

Option B: Lactose-free diet is advised for lactose intolerance. It occurs due to lactase deficiency. Patients usually present with diarrhea, abdominal pain, gassiness, and bloating. A lactose tolerance test or breath hydrogen test may be used for the diagnosis.

Option C: Low-carbohydrate diet is advised for diabetes mellitus.

Reference: Ghai Essential Pediatrics 9th Edition (Page no: 297)

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