Villous Atrophy and Negative Celiac Serology: A Diagnostic and Therapeutic Dilemma

• DOI: 10.1038/ajg.2013.45
• Publication Date: 2013-05-06T07:15:54Z
• Authors: Marisa DeGaetani; Christina A Tennyson; Benjamin Lebwohl; Suzanne K Lewis; Hussein Abu Daya; Carolina Arguelle...; Govind Bhagat; Peter H R Green
• Keywords: Villous atrophy; Immunosuppression; Etiology

Patients with villous atrophy (VA) and negative celiac disease (CD) serologies pose a diagnostic therapeutic dilemma. When definitive etiology for VA is not determined, patients are characterized as having unclassified sprue (US), the optimal management of which unknown.We studied adult on biopsy serologies, evaluated at our tertiary referral center over 10-year period. Testing HLA DQ2/8 alleles, antienterocyte antibodies, giardia stool antigen, bacterial overgrowth, total serum immunoglobulins, HIV was noted. Treatment, response, repeat-biopsy findings were recorded.The most common diagnoses 72 seronegative CD, medication-related atrophy, US. Of those US, majority reported symptomatic improvement immunosuppressive therapy. Some initially labeled found to have associated olmesartan use.The role medications in development dose length immunosuppression US should be investigated further.