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Moving Toward Clinical Consensus on Microscopic Enteritis

Celiac.com 04/20/2015 - Microscopic enteritis is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms, nutrient and micronutrient deficiency. The idea of microscopic enteritis arose from mucosal changes associated with celiac disease and was originally described in detail by Marsh in 1992.

Photo: CC--A. SynMicroscopic enteritis is marked by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy.

A recent study addresses the 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.

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 Microscopic enteritis.

The research team included 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, and Vincenzo Villanacci. 

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The team reviewed statements about the etiology, diagnosis and symptoms associated with microscopic enteritis and proposes an algorithm for its investigation and treatment.  They employed a five-step agreement scale (ranging from strong agreement to strong disagreement) to score 21 statements, independently. They found strong agreement on all statements about Microscopic enteritis histology (95%-100%).

They found 85% to 100% agreement regarding statements concerning diagnosis, while agreement on a statement about the management of microscopic enteritis ranged from the 60% to 100%. They also found general agreement between experts on clinical presentation (75%-95%) and pathogenesis (80%-90%) of Microscopic enteritis.

Lastly, they found strong agreement on the histological definition of Microscopic enteritis. The weaker agreement on management invites further studies, better definitions and clinical trials to produce quality guidelines for management.

This microscopic enteritis consensus is a step toward greater recognition of a significant issue for symptomatic patients previously labelled as non-specific or functional enteropathy.

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