Table 2

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 disordersCommon variable immunodeficiency syndrome
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
Rheumatoid arthritis
Sjögren's syndrome* Systemic lupus erythematosus
Thymoma-associated autoimmune enteropathy
Type I diabetes mellitus*

Hypersensitivity/non-gluten protein intoleranceNon-coeliac gluten sensitivity
Protein intolerance (cows’ milk, soy, eggs, peanuts, cereals)
Cryptosporidium Giardiasis
Helicobacter pylori gastritis†
Postinfectious diarrhoea
Small intestinal bacterial overgrowth
Tropical sprue
Tuberculosis (including atypical TB)
Whipple's disease (for example, HIV)
Non-steroidal anti-inflammatory drugs
Mycophenolate mofetil
NeoplasiaEnteropathy-associated T-cell lymphoma
Immunoproliferative small intestinal disease
Refractory CD type 2
CD 4 T-cell proliferation
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.