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)

A difficult diagnosis of coeliac disease: Repeat duodenal histology increases diagnostic yield in patients with concomitant causes of villous atrophy

“…Furthermore, the largest study on seronegative villous atrophy showed a positive predictive value of 51% for HLA DQ2/DQ8 genotyping [16]. This confirms that also in the setting of SNVA the HLA assay doesn't carry a high positive predictive value.…”

“…This finding is similar to the histopathologic alterations found in untreated CD; however in CD patients, a variable degree of villous atrophy is usually associated with highly sensitive and specific serum antibodies, as anti-endomysial, and anti-tissue transglutaminase antibodies. The real diagnostic dilemma is represented by the patients showing concomitant villous atrophy and seronegative antibodies (SNVA) as they remain in a grey area and many diagnoses other than CD must be considered (Table 1) [15,16]. The combination of the following antibodies EmA-IgA, tTG-IgAb and total IgA is obligatory in basic diagnostic of CD; in the case we reported, both antitTg and EmA antibodies were repeatedly assayed, but they were not reliable because of the antibody deficiency in CVID.…”

Gamma delta+ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy

“…A diagnosis of coeliac disease can be made by demonstrating duodenal villous atrophy and positive coeliac serology (serum IgA tissue transglutaminase –tTG–or endomysial antibodies–EmA) . However, coeliac serology is negative in 6%‐39% of coeliac patients in clinical practice studies (reviewed by Aziz et al) . Despite several sets of international guidelines on coeliac disease, there is no consensus on an approach to subjects with seronegative coeliac disease .…”

Coeliac biopsies: numbers are valid, alphabets not

“…Nevertheless, each set of data is entirely valid2–4 offering forthright, reliable criteria, thus clearly providing one important benchmark. True, seronegative examples are problematic,5 but that is the next study which we will tackle after finishing our current work in progress, to determine whether the same cut-off that we found for Marsh III lesions is also applicable to the less severe Marsh stages.…”