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* Context.-Patients who receive an upper gastrointestinal endoscopic examination frequently have biopsies taken from the duodenum. Accurate interpretation of duodenal biopsies is essential for patient care. Celiac disease is a common clinical concern, but pathologists need to be aware of other conditions of the duodenum that mimic celiac disease.
Objective.-To review the normal histologic features of duodenal mucosa and describe the clinical and histologic findings in celiac disease and its mimics, listing the differentiating features of biopsies with villous atrophy and epithelial lymphocytosis.
Data Sources.-The study comprises a literature review of pertinent publications as of November 30, 2016.
Conclusions.-Celiac disease is a common cause of abnormal duodenal histology. However, many of the histologic features found in the duodenal biopsy of patients with celiac disease are also present in other conditions that affect the small bowel. Diagnostic precision may be enhanced by obtaining a careful patient history and by ancillary laboratory testing, particularly for the presence of antitissue transglutaminase antibodies.
(Arch Pathol Lab Med. 2018;142:35-43; doi: 10.5858/ arpa.2016-0608-RA)
Celiac disease (gluten-sensitive enteropathy) is relatively common in Western countries. However, several causes of duodenal inflammation other than celiac disease have been described and require diagnostic consideration. Causes of duodenal inflammation other than celiac disease may demonstrate the characteristic histologic features of celiac disease, including distortion of villous architecture, prominent infiltration of the lamina propria by inflammatory cells, and increased numbers of intraepithelial lymphocytes (IELs). Here we review the most up-to-date clinical and pathologic criteria for the diagnosis of celiac disease as well as the most common causes of duodenal inflammation that can mimic celiac disease (Table).
NORMAL APPEARANCES
In the investigation of suspected malabsorption, biopsies may be obtained from both the first part of the duodenum (the duodenal bulb) and the second part of the duodenum. Interpretation of the duodenal biopsies must allow for differences between the first and second parts of the duodenum and for the presence of lymphoid aggregates. Both parts of the duodenum have a villous length to crypt depth ratio that is approximately 3:1 to 5:1 (Figure 1). However, in the duodenal bulb, the number of inflammatory cells in the lamina propria is greater, and the villi tend to be shorter and broader, often with branching.1 These differences in normal histology reflect...