Diagnostic Challenges in Enteropathies: A Histopathological Review

Area of Science:

• Gastroenterology and immunology
• Small intestinal mucosal disorders
• Enteropathy diagnostics

Background:

• Enteropathies, including immune-mediated (IME) and infection-related conditions, cause small intestinal injury and malabsorption.
• Celiac disease (CD) is a common IME, but other disorders like autoimmune enteropathy (AIE), small intestinal bacterial overgrowth (SIBO), and tropical sprue (TS) present similar symptoms.
• Overlapping clinical, serological, and histological features complicate the differentiation of these enteropathies from CD.

Purpose of the Study:

• To review the histopathological and clinical features of common immune-mediated enteropathies.
• To focus on distinguishing non-celiac disorders that mimic celiac disease.
• To improve diagnostic accuracy and guide appropriate therapeutic interventions for enteropathies.

Main Methods:

• Review of existing literature on immune-mediated enteropathies and related conditions.
• Analysis of clinical manifestations, serological markers, and histopathological findings.
• Emphasis on differential diagnosis strategies for small bowel biopsy interpretation.

Main Results:

• Recognizes an expanding spectrum of non-celiac enteropathies that mimic CD.
• Highlights the challenges in differentiating various enteropathies due to overlapping features.
• Underscores the importance of a nuanced approach to small bowel biopsy interpretation.

Conclusions:

• Accurate diagnosis of enteropathies is critical to prevent disease progression and complications like malabsorption and enteropathy-associated T-cell lymphoma (EATL).
• A multidisciplinary approach involving gastroenterologists and pathologists is essential for optimizing patient outcomes.
• Enhanced understanding of non-celiac disorders aids in timely and effective treatment of small intestinal mucosal injuries.