<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 24-year-old woman with 45,X syndrome comes to the physician because of diarrhea for 4 months. She also reports bloating, nausea, and abdominal discomfort that persists after defecation. For the past 6 months, she has felt tired and has been unable to do her normal chores. She went on a backpacking trip across Southeast Asia around 7 months ago. She is 144 cm 4 ft 9 in tall and weighs 40 kg 88 lb; BMI is 19 kgm2. Her blood pressure is 11060 mm Hg in the upper extremities and 8040 mm Hg in the lower extremities. Examination shows pale conjunctivae and angular stomatitis. Abdominal examination is normal. Laboratory studies show:Hemoglobin 9.1 mgdLLeukocyte count 5100mm3Platelet count 200,000mm3Mean corpuscular volume 67 μmm3SerumNa 136 mEqLK 3.7 mEqLCl- 105 mEqLGlucose 89 mgdLCreatinine 1.4 mgdLFerritin 10 ngmLIgA tissue transglutaminase antibody positiveBased on the laboratory studies, a biopsy for confirmation of the diagnosis is suggested, but the patient is unwilling to undergo the procedure. Which of the following is the most appropriate next step in management of this patients gastrointestinal symptoms?? A: Metronidazole therapy, B: Avoid milk products, C: Intravenous immunoglobulin therapy, D: Gluten-free diet, E: Trimethoprim-sulfamethaxazole therapy,  <response>: This is a patient with 45,X syndrome Turner syndrome who presents with chronic diarrhea, abdominal discomfort, fatigue, and short stature. The history of recent travel to Southeast Asia raises suspicion for infectious diarrhea. However, the laboratory studies show anemia, leukopenia, thrombocytopenia, and low ferritin, suggesting malabsorption. The positive IgA tissue transglutaminase antibody is consistent with celiac disease, which would explain the malabsorption. Although biopsy confirmation was unable to be obtained, the clinical picture is most consistent with celiac disease. Therefore, the most appropriate next step would be to start the patient on a gluten-free diet.D: Gluten-free diet 