Diagnostic Challenges of Celiac Disease

False-Positive Biopsies

June 2010

We again must be concerned, especially when biopsies have been poorly oriented, of the concept of “flattened biopsies” meaning the patient does not have a flat epithelium, but rather the biopsies have been mal-oriented or flattened so the villi present are not readily seen. Certain drugs can cause injury to the intestine, nonsteroidal anti-inflammatories, for one example. There has also been the condition of self-limited enteritis described. Tropical sprue should be suggested by a travel history to parts of the world where tropical sprue is endemic. Other conditions such as combined variable immunoglobulin deficiency, autoimmune enteropathy, as we have just illustrated, and even the rarer condition of nongranulomatous enterocolitis, can also mimic the pathologic changes of celiac disease.

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False-Positive Biopsies

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• Introduction
• Case 1: Negative Serology for Celiac Disease
• Limitations of Serology
• Case 2: Symptomatic Malabsorption
• Biopsy First?
• Comparison of Serological Tests
• Comparison of Serological Tests
• Marsh Classification
• Autoimmune Enteropathy²
• Autoimmune Enteropathy²
• False-Positive Biopsies
• False-Positive Biopsies
• Minimal Disease: Uncertain Histology
• Lymphocytic Duodenosis⁴
• Patient Presenting on Gluten-free Diet
• What About Patients on Gluten-free Diet?
• Gluten Challenge Testing
• Celiac Disease and HLA Risk
• Genetic Tests-Big Limitation⁵
• References
• Questions?