Celiac Disease and Other Causes of Duodenitis

Arch Pathol Lab Med. 2018 Jan;142(1):35-43. doi: 10.5858/arpa.2016-0608-RA. Epub 2017 Jul 31.


Context: - Patients who receive an upper gastrointestinal endoscopic examination frequently have biopsies taken from the duodenum. Accurate interpretation of duodenal biopsies is essential for patient care. Celiac disease is a common clinical concern, but pathologists need to be aware of other conditions of the duodenum that mimic celiac disease.

Objective: - To review the normal histologic features of duodenal mucosa and describe the clinical and histologic findings in celiac disease and its mimics, listing the differentiating features of biopsies with villous atrophy and epithelial lymphocytosis.

Data sources: - The study comprises a literature review of pertinent publications as of November 30, 2016.

Conclusions: - Celiac disease is a common cause of abnormal duodenal histology. However, many of the histologic features found in the duodenal biopsy of patients with celiac disease are also present in other conditions that affect the small bowel. Diagnostic precision may be enhanced by obtaining a careful patient history and by ancillary laboratory testing, particularly for the presence of antitissue transglutaminase antibodies.

Publication types

  • Review

MeSH terms

  • Angiotensin II Type 1 Receptor Blockers / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Biopsy
  • Blind Loop Syndrome / complications
  • Blind Loop Syndrome / diagnosis
  • Celiac Disease / complications*
  • Celiac Disease / diagnosis*
  • Duodenitis / diagnosis
  • Duodenitis / etiology*
  • Graft vs Host Disease / complications
  • Graft vs Host Disease / diagnosis
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Inflammatory Bowel Diseases / complications
  • Inflammatory Bowel Diseases / diagnosis
  • Intestinal Mucosa / pathology
  • Milk Hypersensitivity / complications
  • Milk Hypersensitivity / diagnosis
  • Polyendocrinopathies, Autoimmune / complications
  • Polyendocrinopathies, Autoimmune / diagnosis
  • Soybean Proteins / adverse effects


  • Angiotensin II Type 1 Receptor Blockers
  • Anti-Inflammatory Agents, Non-Steroidal
  • Immunosuppressive Agents
  • Soybean Proteins

Supplementary concepts

  • Autoimmune enteropathy