Differential Diagnosis of Celiac Disease-Like Changes in a Small Bowel Biopsy

Are you looking at a small bowel biopsy with some villous atrophy and/or a lymphocytic infiltrate?

• infectious gastroenteritis (Whipple disease, HIV-related, viral, Giardia, tropical sprue, other)?

• lymphocytic or collagenous colitis?

• T-cell lymphoma (with refractory sprue)?

• autoimmune enteropathy (rheumatoid arthritis, SLE, Hashimoto's, other)?

• immunodeficiency (hypogamma-globulinemia, IgA deficiency, HIV, other)?

• graft versus host disease (GVHD)?

• inflammatory bowel disease (Crohn's, ulcerative colitis)?

• drug-related injury (NSAIDs, other)?

• bacterial overgrowth and/or luminal stasis?

• non-gluten food hypersensitivity?

• peptic ulcer disease, including Zollinger-Ellison syndrome and Helicobacter pylori infection?

• syndromic diarrhea (THE syndrome)?

• ischemic enteritis?

• microvillous inclusion disease, tufting enteropathy or other early-onset infantile diarrhea?

• chemotherapy and/or radiation related enteritis?

• malnutrition or nutritional deficiency (untreated pernicious anemia, extensive bowel resection, other)?

• eosinophilic gastroenteritis?