Histological mimics of CD in seronegative patients—conditions to be considered for investigation in an appropriate clinical context
| Duodenal histology: normal architecture and increased IELs (≥25/100 enterocytes) or villous atrophy±increased IELs (≥25/100 enterocytes) | ||
|---|---|---|
| Immune disorders | Common variable immunodeficiency syndrome Glomerulonephritis Hypogammaglobulaemia IgA deficiency | |
| Autoimmune disease These patients may have concurrent CD, check serology and HLA status if appropriate* | Autoimmune enteropathy (adults and children) Graves’ disease* Haemolytic anaemia Hashimoto's thyroiditis* Multiple sclerosis Psoriasis | Rheumatoid arthritis Sjögren's syndrome* Systemic lupus erythematosus Thymoma-associated autoimmune enteropathy Type I diabetes mellitus* |
| Hypersensitivity/non-gluten protein intolerance | Non-coeliac gluten sensitivity Protein intolerance (cows’ milk, soy, eggs, peanuts, cereals) | |
| Infection | AIDS Cryptosporidium Giardiasis Helicobacter pylori gastritis† Postinfectious diarrhoea | Small intestinal bacterial overgrowth Tropical sprue Tuberculosis (including atypical TB) Viral Whipple's disease (for example, HIV) |
| Drugs | Chemotherapy Non-steroidal anti-inflammatory drugs Olmesartan Mycophenolate mofetil | |
| Neoplasia | Enteropathy-associated T-cell lymphoma Immunoproliferative small intestinal disease Refractory CD type 2 CD 4 T-cell proliferation | |
| Other | Abetalipoproteinaemia Collagenous colitis Collagenous duodenitis Crohn's disease | Eosinophilic gastroenteritis Glycogen storage disease Microscopic colitis Radiation enteritis Small bowel ischaemia |
*For definition please see text and the Oslo definitions.7
†Common.
CD, coeliac disease; HLA, human leucocyte antigen; IEL, intraepithelial lymphocyte.