Document Detail


Noncoeliac enteropathy: the differential diagnosis of villous atrophy in contemporary clinical practice.
MedLine Citation:
PMID:  22145590     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Duodenal villous atrophy (DVA) is a key diagnostic finding in coeliac disease (CD). However, the differential diagnosis for this finding is broad.
AIM: To identify conditions causing noncoeliac enteropathy (NCE) with villous atrophy and methods to differentiate between CD and NCE in clinical practice.
METHODS: Through record review we identified patients with DVA due to conditions other than CD. Patient demographics, clinical features and relevant investigations were compared with CD patients. Rates of CD misdiagnosis, and response to treatments were recorded.
RESULTS: Thirty cases of NCE were identified with ten different aetiologies. Unspecified immune-mediated enteropathy was the most common aetiology; affecting 10 patients. Gastrointestinal symptoms were more common in NCE than those in CD patients (P < 0.01). Twenty of the 24 NCE patients tested were HLA-DQ2/DQ8 negative. Twenty-six NCE patients were negative for IgA tissue transglutaminase (tTG) (P = 0.0001). Intraepithelial lymphocytosis was absent in 10 (33.3%) patients. Twenty-one NCE patients initially misdiagnosed with CD and one with gluten intolerance were prescribed a gluten free diet (GFD). Fifteen of 22 had repeat biopsy and none showed histological improvement.
CONCLUSIONS: Although coeliac disease is the most common cause of DVA, noncoeliac enteropathy is not rare and may easily be mistaken for coeliac disease. Noncoeliac enteropathy is suggested by a normal initial tTG (87%), lack of intraepithelial lymphocytosis on biopsy, and lack of histological response to a gluten free diet. Subjective response to gluten free diet has poor predictive value for coeliac disease. Noncoeliac enteropathy can often be confirmed by negative HLA-DQ2/DQ8 testing and targeted investigations can ascertain a definitive aetiology in most cases.
Authors:
K Pallav; D A Leffler; S Tariq; T Kabbani; J Hansen; A Peer; A Bhansali; R Najarian; C P Kelly
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-12-06
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  35     ISSN:  1365-2036     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-06     Completed Date:  2012-04-13     Revised Date:  2012-05-17    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  380-90     Citation Subset:  IM    
Copyright Information:
© 2011 Blackwell Publishing Ltd.
Affiliation:
Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA. kpallav@bidmc.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Algorithms
Atrophy
Celiac Disease / diagnosis*,  diet therapy
Diagnosis, Differential
Diet, Gluten-Free
Duodenum / pathology*
Female
HLA-DQ Antigens / metabolism
Humans
Male
Middle Aged
Retrospective Studies
Severity of Illness Index
Young Adult
Grant Support
ID/Acronym/Agency:
K23 DK082619/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/HLA-DQ Antigens; 0/HLA-DQ2 antigen; 0/HLA-DQ8 antigen

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