Clinical clues guiding the diagnosis of enteropathies not posing problems of differential diagnosis with seronegative coeliac disease
| Type of enteropathy | Clinical and laboratory features | Histological/molecular features on duodenal biopsy | Diagnostic tests |
| EATL (type 1 and type 2)68 | Severe malabsorption, abdominal pain, fever, bleeding, obstruction and/or perforation; type 1 most commonly associated to CD, unlike type 2. | Aberrant T cells population on IHC or flow cytometry; TCR monoclonality on PCR. | Inflammatory markers, abdomen CT/PET scan, capsule endoscopy, bone marrow aspirate and haematological consultation. |
| Drug induced*67 69–73 | Severe malabsorption, often with abrupt onset and suggestive pharmacological history. | VA undistinguishable from CD, increased eosinophilic count, preserved neuroendocrine cells. | Duodenal biopsy and drug withdrawal. |
| Chemotherapy74 | Severe malabsorption and suggestive oncological history. | VA undistinguishable from CD, lamina propria fibrosis. | Duodenal biopsy. |
| Radiotherapy75 | Severe malabsorption and history of radiotherapy. | Lamina propria fibrosis. | Duodenal biopsy. |
| GVHD76 | Severe malabsorption and history of bone marrow transplantation. | Crypt cell necrosis and loss of epithelium. | Duodenal biopsy. |
| HIV enteropathy77 | Known history of AIDS, presence of opportunistic infections. | Decrease CD4+ T lymphocytes and increase in CD8+ T lymphocytes. | HIV test. |
| Eosinophilic gastroenteritis78 | History of atopy and allergies, after exclusion of parasites. | Massive eosinophilic infiltration on duodenal biopsy. | Duodenal biopsy and peripheral hyper-eosinophilia. |
| Crohn’s disease79 | Bloody diarrhoea, abdominal pain, fever, elevated CRP, ESR and faecal calprotectin. | Aftous ulcers and granulomas. | Colonoscopy+biopsy, duodenal biopsy, entero-MRI. |
*This includes angiotensin II receptor blockers particularly olmesartan, azathioprine, micophenolate mophetile and methotrexate.
CD, coeliac disease; CRP, C reactive protein; -EATL, enteropathy associated T-cell lymphoma; ESR, erythro-sedimentation rate; GVHD, graft-versus-host disease; IHC, immunohistochemistry; PCR, polymerase chain reaction; TCR, T-cell receptor; VA, villous atrophy.