Diagnostic Challenges of Celiac Disease

Lymphocytic Duodenosis⁴

June 2010

This condition also known as lymphocytic duodenosis is really a pathologic finding on duodenal biopsies. It is not a diagnosis in itself. It is characterized by raised intraepithelial lymphocytosis. About 20% of patients with this finding may actually have celiac disease, but most do not. It can also be seen in patients with known celiac disease who are not compliant with their diet.

Anti-inflammatories, autoimmune disease, inflammatory bowel disease, giardiasis and a host of other conditions can mimic this change.

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Lymphocytic Duodenosis4

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Jump to section:

• 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?