Diagnostic Challenges of Celiac Disease

Autoimmune Enteropathy²

June 2010

Not all that flattens is celiac disease. This is a case of a 65-year-old male with a history of diarrhea and weight loss. The tissue transglutaminase antibody and endomysial antibodies were performed and were negative. The patient had no response to a gluten-free diet. His intestinal biopsies showed quite substantial change with inflammation, partial villous atrophy, marked crypt hyperplasia and, this photo micrograph illustrates, the dense lymphoplasmacellular infiltrate. And, to the untrained eye, one would say this looks very much like celiac disease. However, the patient’s lack of response and negative serology at the time of initial diagnosis should alert the clinician that this may not be celiac disease and there may be an alternative explanation.

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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?