Post by kickingfrog on Mar 2, 2014 18:56:18 GMT
Villous Atrophy and Negative Celiac Serology:
A Diagnostic and Therapeutic Dilemma
Marisa DeGaetani, MD1,2, Christina A. Tennyson, MD1,2, Benjamin Lebwohl, MD, MS1,2, Suzanne K. Lewis, MD1,2, Hussein Abu Daya, MD1
,
Carolina Arguelles-Grande, MD1
, Govind Bhagat, MBBS3
and Peter H.R. Green, MD1,2
objectives: Patients with villous atrophy (VA) and negative celiac disease (CD) serologies pose a diagnostic and
therapeutic dilemma. When a definitive etiology for VA is not determined, patients are characterized
as having unclassified sprue (US), the optimal management of which is unknown.
methods: We studied adult patients with VA on biopsy and negative celiac serologies, evaluated at our tertiary
referral center over a 10-year period. Testing for HLA DQ2/8 alleles, antienterocyte antibodies, giardia
stool antigen, bacterial overgrowth, total serum immunoglobulins, and HIV was noted. Treatment,
response, and repeat-biopsy findings were recorded.
results: The most common diagnoses of the 72 patients were seronegative CD, medication-related
villous atrophy, and US. Of those with US, the majority reported symptomatic improvement with
immunosuppressive therapy. Some patients initially labeled as unclassified were found to have VA
associated with olmesartan use.
conclusions: The role of medications in the development of VA and the optimal dose and length of
immunosuppression for patients with US should be investigated further.
Am J Gastroenterol 2013;108:647–653; doi:10.1038/ajg.2013.45
sklad.cumc.columbia.edu/celiacdiseasecenter/wp-content/uploads/2013-Villous-atrophy-and-negative-celiac-serology-a-diagnostic-and-therapeutic-dilemma.pdf
A Diagnostic and Therapeutic Dilemma
Marisa DeGaetani, MD1,2, Christina A. Tennyson, MD1,2, Benjamin Lebwohl, MD, MS1,2, Suzanne K. Lewis, MD1,2, Hussein Abu Daya, MD1
,
Carolina Arguelles-Grande, MD1
, Govind Bhagat, MBBS3
and Peter H.R. Green, MD1,2
objectives: Patients with villous atrophy (VA) and negative celiac disease (CD) serologies pose a diagnostic and
therapeutic dilemma. When a definitive etiology for VA is not determined, patients are characterized
as having unclassified sprue (US), the optimal management of which is unknown.
methods: We studied adult patients with VA on biopsy and negative celiac serologies, evaluated at our tertiary
referral center over a 10-year period. Testing for HLA DQ2/8 alleles, antienterocyte antibodies, giardia
stool antigen, bacterial overgrowth, total serum immunoglobulins, and HIV was noted. Treatment,
response, and repeat-biopsy findings were recorded.
results: The most common diagnoses of the 72 patients were seronegative CD, medication-related
villous atrophy, and US. Of those with US, the majority reported symptomatic improvement with
immunosuppressive therapy. Some patients initially labeled as unclassified were found to have VA
associated with olmesartan use.
conclusions: The role of medications in the development of VA and the optimal dose and length of
immunosuppression for patients with US should be investigated further.
Am J Gastroenterol 2013;108:647–653; doi:10.1038/ajg.2013.45
sklad.cumc.columbia.edu/celiacdiseasecenter/wp-content/uploads/2013-Villous-atrophy-and-negative-celiac-serology-a-diagnostic-and-therapeutic-dilemma.pdf