Practical Approach to the Flattened Duodenal Biopsy

Area of Science:

• Gastroenterology
• Histopathology
• Immunology

Background:

• Celiac disease is characterized by duodenal intraepithelial lymphocytosis, which may or may not be accompanied by villous atrophy.
• Diagnosing celiac disease can be complex, as lymphocytosis without villous atrophy is confirmed in 10-20% of cases, and mimics exist even with villous atrophy.

Purpose of the Study:

• To outline the diagnostic considerations for celiac disease based on duodenal biopsy findings.
• To differentiate celiac disease from other conditions presenting with similar histological features.

Main Methods:

• Review of histological features in duodenal biopsies.
• Analysis of differential diagnoses for intraepithelial lymphocytosis with and without villous atrophy.

Main Results:

• Lymphocytosis without villous atrophy represents celiac disease in 10-20% of cases.
• Conditions such as Helicobacter pylori gastritis, NSAID injury, and bacterial overgrowth are in the differential diagnosis.
• Mimics of celiac disease with villous atrophy include collagenous sprue, tropical sprue, drug injury, and common variable immunodeficiency.

Conclusions:

• Histological clues such as paucity of plasma cells, excess neutrophils, granulomas, and relative paucity of intraepithelial lymphocytes suggest diagnoses other than celiac disease.
• Accurate histological interpretation is crucial for differentiating celiac disease from its mimics.