Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2593
Peer-review started: October 27, 2014
First decision: November 26, 2014
Revised: December 29, 2014
Accepted: January 21, 2015
Article in press: January 21, 2015
Published online: March 7, 2015
Microscopic enteritis (ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy. This work recognises a need to characterize disorders with microscopic and submicroscopic features, currently regarded as functional or non-specific entities, to obtain further understanding of their clinical relevance. The consensus working party reviewed statements about the aetiology, diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment. Following the 5th International Course in Digestive Pathology in Bucharest in November 2012, an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME. A five-step agreement scale (from strong agreement to strong disagreement) was used to score 21 statements, independently. There was strong agreement on all statements about ME histology (95%-100%). Statements concerning diagnosis achieved 85% to 100% agreement. A statement on the management of ME elicited agreement from the lowest rate (60%) up to 100%. The remaining two categories showed general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of ME. There was strong agreement on the histological definition of ME. Weaker agreement on management indicates a need for further investigations, better definitions and clinical trials to produce quality guidelines for management. This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.
Core tip: This is a global consensus on the classification, etiology, diagnosis and multidisciplinary treatment of milder enteropathy. There is no such thing as non-specific. The consensus on microscopic enteritis (ME) brings an end to the era of the non-specificities and opens a new prospect in characterisations of milder enteropathies including submicroscopic small intestinal mucosal changes in patients presenting with unexplained malabsorption syndrome and other category of so called non-specific gastrointestinal disorders. Recognition of ME is the first step toward identifying the masked etiologies under the out of date diagnoses like irritable bowel syndrome and other so called functional gut disorders. It proposes the algorithm for imposing specific targeted treatment according to the etiologies instead of symptomatic treatment aiming to prevent the long term comorbidities.