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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2593-2604
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2593
Microscopic enteritis: Bucharest consensus
Kamran Rostami, David Aldulaimi, Geoffrey Holmes, Matt W Johnson, Marie Robert, Amitabh Srivastava, Jean-François Fléjou, David S Sanders, Umberto Volta, Mohammad H Derakhshan, James J Going, Gabriel Becheanu, Carlo Catassi, Mihai Danciu, Luke Materacki, Kamran Ghafarzadegan, Sauid Ishaq, Mohammad Rostami-Nejad, A Salvador Peña, Gabrio Bassotti, Michael N Marsh, Vincenzo Villanacci
Kamran Rostami, David Aldulaimi, Luke Materacki, Department of Gastroenterology, Alexandra Hospital, Worcestershire B98 7UB, United Kingdom
Geoffrey Holmes, Department of Gastroenterology, Royal Derby Hospital, Derby DE22 3NE, United Kingdom
Matt W Johnson, Gastroenterology Unit Luton, Dunstable University FT Hospital LU4 0DZ, United Kingdom
Marie Robert, Department of Pathology and Medicine, Yale University School of Medicine, New Haven, CT 06520, United States
Amitabh Srivastava, Department of Pathology, Staff Pathologist, Brigham and Women’s Hospital, Harvard Medical School Boston, Boston, MA 02115, United States
Jean-François Fléjou, Department of Pathology, Service d’Anatomie Pathologique, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie, 75005 Paris, France
David S Sanders, Department of Gastroenterology, University of Sheffield, South Yorkshire S10 2TN, United Kingdom
Umberto Volta, Department of Gastroenterology, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
Mohammad H Derakhshan, Section of Gastroenterology, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
James J Going, Department of Pathology, Southern General Hospital, Lanarkshire G51 4TF, United Kindom
Gabriel Becheanu, Department of Pathology, Carol Davila Univerity of Medicine and Pharmacy, Bucharest 050474, Romania
Carlo Catassi, Università Politecnica delle Marche, Ancona, Italy, Presidente Società Italiana di Gastroenterologia, Epatologia e Nutrizione Pediatrica, Co-Director, Center For Celiac Research, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Mihai Danciu, Grigore T Popa” University of Medicine and Pharmacy, Iasi 747800, Romania
Kamran Ghafarzadegan, Laboratory Department Mashad, Razavi Hospital, Khorasan Razavi 9177948564, Iran
Sauid Ishaq, Dudley group of Hospitals, Birmingham City University, Birmingham B42 2SU, United Kindom
Mohammad Rostami-Nejad, Gastroenterology and Liver Diseases Research Institute, Shahid Beheshti University of Medical Sciences, Tehran 1985714711, Iran
A Salvador Peña, Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Vrije Universiteit medical centre (VUmc), 1081 HZ Amsterdam, The Netherlands
Gabrio Bassotti, Gastroenterology Section, Department of Medicine, University of Perugia Medical School, 06100 Perugia, Italy
Michael N Marsh, Wolfson College, University of Oxford, Oxford OX2 6UD, United Kingdom
Vincenzo Villanacci, Institute of Pathology Spedali Civili, 25123 Brescia, Italy
Author contributions: Rostami K and Becheanu G organised the Consensus Meeting and the authors agreed on consensus objectives; all authors completed the consensus questionnaire; Rostami K coordinated the study and consensus manuscript; Rostami K, Aldulaimi D and Materacki L wrote the first draft of manuscript; Holmes G, Johnson MW, Robert M, Srivastava A, Fléjou JF, Sanders DS, Volta U, Derakhshan MH, Going JJ, Bassotti G, Catassi C, Danciu M, Ghafarzadegan K, Ishaq S, Rostami-Nejad M,Peña AS, Marsh MN and Villanacci V revised critically the manuscript in numerous occasions and contributed in re-writing and approving the last draft.
Conflict-of-interest: Non declared on behalf of all authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kamran Rostami, MD, PhD, Consultant Physician, Department of Gastroenterology, Alexandra Hospital, Woodrow Drive, Redditch. Worcestershire B98 7UB, United Kingdom. kamran.rostami@nhs.net
Telephone: +44-1527-503030 Fax: +44-1527-512075
Received: October 19, 2014
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
Processing time: 141 Days and 14.7 Hours
Abstract

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.

Keywords: Microscopic enteritis; Enteropathy; Gluten; Malabsorption; Non-celiac gluten; Bucharest consensus

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.