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: firstname.lastname@example.org
Received October 5, 2018
Accepted November 9, 2018