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Overview in the clinical management of patients with seronegative villous atrophy

Schiepatti, Annalisaa,c,d; Sanders, David S.d; Zuffada, Martinaa; Luinetti, Ombrettab; Iraqi, Adama; Biagi, Federicoa

European Journal of Gastroenterology & Hepatology: April 2019 - Volume 31 - Issue 4 - p 409–417
doi: 10.1097/MEG.0000000000001340
Review Articles

Differential diagnosis and management of enteropathies found in the context of seronegative villous atrophy (VA) are still a clinical challenge. Although seronegative coeliac disease may be the most frequent cause of serology-negative VA, other conditions must be taken into account in the differential diagnosis of seronegative VA. The rarity of these enteropathies with frequent overlapping of histological features may result in misclassification of such patients as affected by a seronegative or a refractory form of coeliac disease with consequent inappropriate treatments and long-term morbidity. The aim of this review is to summarize the current knowledge and to provide an evidence base and practical algorithmic approach for the investigation and management of seronegative VA.

aCoeliac Centre/First Department of Internal Medicine

bDepartment of Pathology, Fondazione Policlinico San Matteo

cDepartment of Experimental Medicine, University of Pavia, Pavia, Italy

dAcademic Department of Gastroenterology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK

Correspondence to Annalisa Schiepatti, MD, First Department of Internal Medicine, Coeliac Centre, IRCCS Policlinico San Matteo Pavia, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy Tel: +39 038 250 2284/2559; fax: +39 038 250 2618; e-mail:

Received October 5, 2018

Accepted November 9, 2018

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