Small bowel villous atrophy: celiac disease and beyond

ABSTRACT

Introduction: Small bowel villous atrophy can represent a diagnostic challenge for gastroenterologists and pathologists. In Western countries small bowel atrophy and mild non-atrophic alterations are frequently caused by celiac disease. However, other pathology can mimic celiac disease microscopically, widening the differential diagnosis. The several novelties on this topic and the introduction of the device-assisted enteroscopy in the diagnostic flowchart make an update of the literature necessary.

Areas covered: In this review, a description of the different clinical scenarios when facing with small bowel mucosal damage, particularly small bowel atrophy, is described. The published literature on this subject has been summarized and reviewed.

Expert commentary: When an intestinal mucosal alteration is histologically demonstrated, the pathology report forms part of a more complex workup including serological data, clinical presentation and clinical history. A multidisciplinary team, including pathologists and enteroscopy-devoted endoscopists, is frequently required to manage patients with small bowel alterations, especially in cases of severe malabsorption syndrome.

KEYWORDS:

• Small bowel atrophy
• enteritis
• gluten
• celiac disease
• infections
• autoimmune enteritis

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

For the purpose of this project, A. Assiri and the Chicago Celiac Disease Center were supported by King Saud University through the vice deanship of research chairs. The Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca’ Granda was funded by “Ministero della Salute and Regione Lombardia Bando R.F.GR 2011-02348234 A capsule endoscopy and double balloon enteroscopy sequential approach for early detection of gastrointestinal tumors in celiac disease: a prospective trial”.