Patients with villous atrophy (VA) and negative celiac disease 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.
Dr Marisa DeGaetani and colleagues from New York, USA 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.
|One of the most common diagnoses of the 72 patients was seronegative celiac disease|
|American Journal of Gastroenterology|
Treatment, response, and repeat-biopsy findings were recorded.
The researchers noted that the most common diagnoses of the 72 patients were seronegative celiac disease, medication-related villous atrophy, and US.
Of those with US, the majority reported symptomatic improvement with immunosuppressive therapy.
The research team reported that some patients initially labeled as unclassified were found to have VA associated with olmesartan use.
Dr DeGaetani's team concludes, "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."