Celiac disease

A 15-year-old female comes to her primary care physician for evaluation of abdominal pain, bloating, and diarrhea. The symptoms began several months ago. She describes the diarrhea as bulky and foul-smelling. Over the past week, the patient also developed a pruritic rash on the bilateral forearms. Past medical history is significant for type I diabetes mellitus, which is well managed with insulin. She recently traveled to Mexico and ate food from local street vendors. Vital signs are within normal limits. Physical examination reveals conjunctival pallor, as well as multiple tense, grouped blisters on her forearms and excoriations. The abdomen is mildly tender to palpation. Laboratory testing reveals positive anti-tissue transglutaminase antibodies. If this patient’s condition is untreated, which of the following complications is she at greatest risk of developing?