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Improving basic skills in celiac-like disease diagnosis: a case report.

Vito Domenico Corleto1,2, Vincenza Patrizia Di Marino3, Gloria Galli4

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Coeliac disease diagnosis requires multiple tests, as villous atrophy can mimic other conditions like giardiasis. This case highlights the importance of comprehensive assessment for accurate diagnosis.

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Area of Science:

  • Gastroenterology
  • Internal Medicine
  • Parasitology

Background:

  • Coeliac disease (CD) diagnosis relies on symptoms, antibodies, and duodenal villous atrophy.
  • Villous atrophy, a CD hallmark, is not specific and can occur in other gastrointestinal disorders.
  • Giardiasis, a common protozoan infestation, can cause duodenal mucosal damage mimicking CD.

Observation:

  • A 42-year-old woman presented with dyspeptic symptoms, fatigue, and diarrhea.
  • Initial tests for CD and parasites were negative; endoscopy showed gastritis and duodenal villous atrophy (Marsh type 3b).
  • Gluten-free diet (GFD) did not improve symptoms; revised duodenal biopsies revealed Giardia trophozoites.

Findings:

  • Giardiasis was confirmed by duodenal biopsy and stool examination.
  • Treatment with metronidazole resolved diarrhea; GFD was discontinued.
  • Eradication of Helicobacter pylori and resolution of gastrointestinal symptoms occurred after 6 months.

Implications:

  • This case underscores that duodenal villous atrophy alone does not confirm CD.
  • Accurate diagnosis requires a multi-step approach integrating clinical, serological, and histological findings.
  • Giardiasis should be considered in the differential diagnosis of villous atrophy, especially when GFD is ineffective.