Taha Qazi, MD: Assessing Common Causes of Seronegative Villous Atrophy

Celiac disease is the most common cause of enteropathy, affecting approximately 1% of the population in the United States.

Most patients with duodenal villous atrophy have seropositive celiac disease, defined as the serologic presence of IgA tissue transglutaminase and/or endomysial antibodies. However, when villous atrophy is discovered in the context of negative celiac serology testing, it presents a clinical challenge.

The seventh issue of Qazi Corner, a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD, spotlights a study exploring the differential diagnosis of seronegative villous atrophy through a review of clinical and histological criteria to determine the most common causes of this entity.

“What [this study] found is that there's a variety of things that this could be related to. There are some situations where patients have celiac disease and it truly is seronegative celiac disease, meaning they have celiac disease but the blood testing is not positive,” Qazi explained. “That can be for a variety of reasons, and the majority of patients in this cohort who had this condition had true celiac disease, but they didn't have the blood test that we used to diagnose them.”

Qazi went on to outline other potential causes, including Crohn’s disease, medication-induced, small bowel overgrowth, and a number of different sources that could cause this entity.

“When we are looking at a patient who comes in and has what looks like villous atrophy, the telltale sign of celiac disease, but when you do the blood testing, it comes back negative, I think we should keep the differential broad. Common things being common, it could still be seronegative celiac disease, and that's what this study suggests, that the majority of these patients, about 22%, had had seronegative celiac disease, probable.”

Despite this finding, Qazi continued to emphasize the importance of considering other things it could be linked to and keeping the differential broad.

Dr. Chiara Maruggi’s article: The Clinical Challenge of Seronegative Villous Atrophy: A Preview