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Semin Diagn Pathol. 2014 Mar;31(2):124-36. doi: 10.1053/j.semdp.2014.02.006. Epub 2014 Feb 12.

A practical approach to small bowel biopsy interpretation: celiac disease and its mimics.

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  • 1Department of Anatomic Pathology, Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195. Electronic address:


While celiac disease is the most common cause of villous remodeling and intraepithelial lymphocytosis in the proximal small bowel, there are many entities that can mimic its histologic appearance. The purpose of this review is to discuss normal small bowel histology and the differential diagnosis of celiac disease. Approaches to evaluate increased intraepithelial lymphocytes are presented, followed by a detailed discussion of the pathology of celiac disease. Particular emphasis is given to those conditions that cause intraepithelial lymphocytosis in the setting of preserved villous architecture, although other important entities, such as peptic injury, idiopathic inflammatory bowel disease, medication injury, eosinophilic (allergic) gastroenteritis, autoimmune enteropathy, common variable immunodeficiency, and infections are also reviewed.


Differential diagnosis; Gluten; Intraepithelial lymphocytosis; Sprue; Villous architecture

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