Self‐limited coeliac‐like enteropathy: a series of 18 cases highlighting another coeliac disease mimic

Abstract

Histopathologists need to be aware that a coeliac disease-like enteropathy may occur in the setting of an acute gastrointestinal illness and resolve without sequelae.

The clinical and phenotypical assessment of seronegative villous atrophy; a prospective UK centre experience evaluating 200 adult cases over a 15-year period (2000–2015)

“…Third, we have unanswered questions in those in whom no cause was found (so called idiopathic/unclassified sprue) but spontaneously normalised duodenal biopsies while consuming high-dose gluten. A recent case series has highlighted that self-limiting enteropathies can occur in the context of GI infections,23 which raises the possibility that our patients may have experienced a similar insult although this was not recalled from their clinical history nor isolated from stool cultures. Furthermore, these individuals had their repeat biopsy performed on average 9 months after the index case which had shown villous atrophy.…”

“…The causes of seronegative non-CD (SN-non-CD) are vast ranging from infective, inflammatory, immune-mediated and drug-related 16 17. Such examples include autoimmune enteropathy,20 bacterial overgrowth,16 common variable immunodeficiency,21 Crohn's disease,22 gastroenteritis,23 giardiasis,24 25 graft versus host disease,26 HIV enteropathy,27 mycobacterium tuberculosis,25 28 peptic duodentitis± H. pylori ,17 29–32 radiation enteritis,33 tropical sprue25 34 and Whipple's disease 35. Medications include non-steroidal anti-inflammatory drugs,36–38 azathioprine,39 methotrexate,40 mycophenolate mofetil41 and, most recently, angiotensin-2-receptor-blockers (A2RBs), in particular olmesartan 16 42–45.…”

The role of histopathology in the diagnosis and management of coeliac disease and other malabsorptive conditions

“…similar symptoms in close contacts has led to the suggestion of viral infection as the cause, although this is seldom confirmed. 100 However, there is direct evidence that coeliac-like enteropathy can be initiated by norovirus infections and other viral infections, so it is likely that a transient viral enteritis could explain many of these cases. 101,102 Neutrophil infiltration, epithelial degeneration and crypt apoptosis are often found in biopsies in this scenario.…”

“…101,102 Neutrophil infiltration, epithelial degeneration and crypt apoptosis are often found in biopsies in this scenario. 100 Small-intestine bacterial overgrowth. Predisposing factors for bacterial overgrowth include a reduced level of gastric acid (e.g.…”

ROC-king onwards: intraepithelial lymphocyte counts, distribution and role in coeliac disease mucosal interpretation

“…However, it may alert clinicians to the danger of false diagnoses. The lower the probability of CD the more thoroughly histologically possible differential diagnoses3 such as giardiasis,4 viral or bacterial infections,5 tropical sprue, bacterial overgrowth or drug-induced lesions6 have to be excluded by clinicians and surgical pathologists alike.…”