Small bowel villous atrophy: celiac disease and beyond

Luca Elli, Federica Branchi, Reena Sidhu, Stefano Guandalini, Asaad Assiri, Firas Rinawi, Raanan Shamir, Prasenjit Das, Govind K. Makharia

Research output: Contribution to journalReview articlepeer-review


Introduction: Small bowel villous atrophy can represent a diagnostic challenge for gastroenterologists and pathologists. In Western countries small bowel atrophy and mild non-atrophic alterations are frequently caused by celiac disease. However, other pathology can mimic celiac disease microscopically, widening the differential diagnosis. The several novelties on this topic and the introduction of the device-assisted enteroscopy in the diagnostic flowchart make an update of the literature necessary. Areas covered: In this review, a description of the different clinical scenarios when facing with small bowel mucosal damage, particularly small bowel atrophy, is described. The published literature on this subject has been summarized and reviewed. Expert commentary: When an intestinal mucosal alteration is histologically demonstrated, the pathology report forms part of a more complex workup including serological data, clinical presentation and clinical history. A multidisciplinary team, including pathologists and enteroscopy-devoted endoscopists, is frequently required to manage patients with small bowel alterations, especially in cases of severe malabsorption syndrome.

Original languageEnglish
Pages (from-to)125-138
Number of pages14
JournalExpert Review of Gastroenterology and Hepatology
Issue number2
Publication statusPublished - Feb 1 2017


  • autoimmune enteritis
  • celiac disease
  • enteritis
  • gluten
  • infections
  • Small bowel atrophy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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