Practical Approach to the Flattened Duodenal Biopsy

Thomas C. Smyrk

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Celiac disease features duodenal intraepithelial lymphocytosis with or without villous atrophy. Lymphocytosis without villous atrophy will be proven to represent celiac disease in 10% to 20% of cases. The differential diagnosis is broad: Helicobacter pylori gastritis, NSAID injury and bacterial overgrowth are considerations. Lymphocytosis with villous atrophy is very likely to be celiac disease, but there are mimics to consider, including collagenous sprue, tropical sprue, drug injury, and common variable immunodeficiency. Histologic clues to a diagnosis other than celiac disease include paucity of plasma cells, excess of neutrophils, granulomas, and relative paucity of intraepithelial lymphocytes.

Original languageEnglish (US)
Pages (from-to)823-839
Number of pages17
JournalSurgical Pathology Clinics
Issue number4
StatePublished - Dec 2017


  • Celiac disease
  • Collagenous sprue
  • Common variable immunodeficiency
  • Intraepithelial lymphocytes
  • Tropical sprue

ASJC Scopus subject areas

  • Surgery
  • Pathology and Forensic Medicine


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