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Related Experiment Video

Updated: May 3, 2026

Author Spotlight: Designing Sustainable Nanomaterials for Advancing Synthesis and Element Mixing

Author Spotlight: Designing Sustainable Nanomaterials for Advancing Synthesis and Element Mixing

Published on: March 15, 2024

All that glitters is not always gold.

E Harrison¹, S Hayes, L Howell

¹Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.

BMJ Case Reports

|February 12, 2014

Summary

Seronegative coeliac disease can be challenging to diagnose, especially when a gluten-free diet fails. This case highlights the importance of considering small intestinal bacterial overgrowth as an alternative cause of villous blunting.

Area of Science:

Gastroenterology
Pathology

Background:

Duodenal biopsies are standard for unintentional weight loss.
Villous atrophy and intraepithelial lymphocytosis often indicate coeliac disease.

Observation:

A 74-year-old woman with seronegative coeliac disease did not improve on a gluten-free diet.
Her presentation involved villous blunting, a finding not always specific to coeliac disease.

Findings:

Severe villous atrophy (Marsh IIIc) is highly specific for coeliac disease, though rare.
Milder abnormalities (Marsh I-II, Marsh IIIa) can mimic coeliac disease and suggest other conditions.

Implications:

This case underscores the need for differential diagnosis in suspected coeliac disease.

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Small intestinal bacterial overgrowth is a key alternative diagnosis for villous blunting unresponsive to a gluten-free diet.