Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.573
Peer-review started: September 2, 2016
First decision: September 21, 2016
Revised: October 27, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: January 28, 2017
The upper digestive tract is routinely scoped for several causes of malabsorption, and the number of duodenal biopsy specimens has increased notably in the last 10 years. Gluten-sensitive enteropathy (GSE) is an autoimmune disease, which shows an increasing prevalence worldwide and requires a joint clinico-pathological approach. The classical histopathology of GSE with partial or total villous blunting is well recognized, but the classification of GSE is not straightforward. Moreover, several mimickers of GSE with intraepithelial lymphocytosis have been identified in the last 20 years, with drug interactions and medical comorbidities adding to the conundrum. In this review, we report on the normal duodenal mucosa, the clinical presentation and laboratory diagnosis of GSE, the duodenal intraepithelial lymphocytes and immunophenotype of GSE-associated lymphocytes, the GSE mimickers, the differences “across oceans” among guidelines in diagnosing GSE, and the use of a synoptic report for reporting duodenal biopsies in both children and adults in the 21st century.
Core tip: Striking and unique microphotographs with comparison of classification of gluten-sensitive enteropathy across oceans and tables useful for the practice of gastroenterology.