Other Reasons Villi Blunting

[holdthegluten]

If a biopsy reveals villi blunting, why does that guarantee you have celiac. I have read that villi blunting can be caused by many other factor. Other food intolerances (soy,casein,anything with high IgA reaction), gastroenteritis, and malnutrition can cause blunting. My question is if you have some other food intolerance and blunted villi, it might not mean celiac..........correct? I had a TTG level of 8 , which is questionable regarding celiac, then my biopsy revealed blunted villi, so i was diagnosed with celiac. Then i was tested through enterolab for soy intolerance and it was 10, which is positive and i should remove soy from my diet. Could the soy intolerance have done the villi blunting. Being that i havent felt much better since removing gluten i have been wondering if i have been misdiagnosed. What would be my next step?

[psawyer]

From what you say, it sounds to me that you are a celiac who is also intolerant to soy.

What is your source for saying that other factors can cause villi blunting? Can you provide a proper study to support this?

Your next step is a diet which is both soy-free and gluten-free.

[2kids4me]

Villi blunting can have othe causes, but the pathologist examining biopsy specimens - looks for specific things and the pathologist will send a report to the doctor outlining in detail - his findings, followed by "histologic findings consistent with celiac sprue"....if it is celiac ...or if the biopsy had findings associated with allergy - he/she would note that. They do not just look and say "the villi are blunted" - pathologists perform a detailed examination of tissue samples and determine cells types [normal/abnormal ]. They offer a diagnosis if their findings are consistent with a specific disease.

I have included a link and some info from that link : (it is very medical so I took the basics from it)

Open Original Shared Link

In small-bowel mucosal biopsy specimens, they look for:

-Increased intraepithelial lymphocytes This is the first and most sensitive marker of the effects of gluten on the small-bowel mucosa; thus, it is the major histological feature of celiac disease.

- Increased cellularity in the lamina propria. In celiac disease with villous/crypt abnormalities, plasma cells, lymphocytes, and eosinophils are increased in number, particularly in the upper half of the mucosa. The number of eosinophils may be striking; however, their increase is paralleled by the increase in mononuclear inflammatory cells, a finding that is against a diagnosis of allergic enteritis. Neutrophils are also part of the inflammatory response and may be numerous in the lamina propria . However, if they are associated with cryptitis or crypt abscesses, an alternative diagnosis (such as autoimmune enteropathy, peptic injury, or Crohn's disease) should be considered.

-The combination of clinical, serologic, and histologic findings plus response to a gluten-free diet confirms the diagnosis of celiac disease in most patients.

On biopsy, however, some other conditions can mimic aspects of celiac disease. Some of these conditions and useful differential diagnostic points are summarized here:

- Autoimmune enteropathy: crypt injury/destruction; anti-enterocyte antibodies in 50% of cases. Onset usually in the first 6 months after birth.

-Tropical sprue: lack of antiendomysial antibodies; response to antibiotic and folate therapy.

-Common variable immunodeficiency: paucity or absence of plasma cells; marked lymphoid nodular hyperplasia; Giardia infection common.

-Infectious (usually viral) enteritis: normal IEL counts.

-Food protein intolerance (eggs, cow milk, etc.): increased eosinophils; other allergic manifestation (asthma, atopy); response to elimination diets.

-Development of lymphoma: atypical lymphoid infiltrate; high index of suspicion; imaging studies that demonstrate mass lesions.

sandy

[holdthegluten]

From what you say, it sounds to me that you are a celiac who is also intolerant to soy.

What is your source for saying that other factors can cause villi blunting? Can you provide a proper study to support this?

Your next step is a diet which is both soy-free and gluten-free.

You could read it on enterolab.com. Anything that causes a high IgA reaction can do damage.

[psawyer]

I will look at the source you mention.

I still think that you should try a soy- and gluten-free diet. Your results show indications of both intolerances.

If your symptoms disappear on this diet, you could try reintroducing a gluten source (plain bread is the easiest and clearest) to see it symptoms recur. If a couple of weeks of eating ordinary bread does not cause symptoms, then it is likely that you only react to soy. Soy is easier to avoid than gluten. It is a single-source protein and is included in the "top 8" allergens so it should always be clearly labeled.

[holdthegluten]

I will look at the source you mention.

I still think that you should try a soy- and gluten-free diet. Your results show indications of both intolerances.

If your symptoms disappear on this diet, you could try reintroducing a gluten source (plain bread is the easiest and clearest) to see it symptoms recur. If a couple of weeks of eating ordinary bread does not cause symptoms, then it is likely that you only react to soy. Soy is easier to avoid than gluten. It is a single-source protein and is included in the "top 8" allergens so it should always be clearly labeled.

Thanks. I am gy no means planning on going off this gluten free diet that i have been on for 9 months, but i havent felt great since going gluten free and soy free and dairy free. I am just wondering why i dont feel great. I am postive that i have been following the gluten free diet as my blood test results have revealed (TTG less than 4). Im just looking for possible answers. Thanks for your thoughts.

[Rachel--24]

You could read it on enterolab.com. Anything that causes a high IgA reaction can do damage.

Where does it say that any food intolerance can cause blunted villi?? I have never read that on Enterolab's site (or anywhere else).

Its true that any food intolerance can cause damage....as in inflammation contributing to leaky gut...but thats a seperate issue from blunted villi.

For example....Enterolab tests IgA antibodies for yeast and egg in the stool....I have never read anywhere of a link between these foods and blunted villi consistent with Celiac Disease.

I have heard of casein causing blunted villi in some cases but I dont think its a common occurance.

[Rachel--24]

Thanks. I am gy no means planning on going off this gluten free diet that i have been on for 9 months, but i havent felt great since going gluten free and soy free and dairy free. I am just wondering why i dont feel great. I am postive that i have been following the gluten free diet as my blood test results have revealed (TTG less than 4). Im just looking for possible answers. Thanks for your thoughts.

Its possible you have other issues not related to Celiac Disease. Many people have more than one thing going on contributing to their symptoms. It doesnt mean the Celiac was misdiagnosed....it just means that you might have additional problems which havent been identified yet.

[holdthegluten]

Where does it say that any food intolerance can cause blunted villi?? I have never read that on Enterolab's site (or anywhere else).

Its true that any food intolerance can cause damage....as in inflammation contributing to leaky gut...but thats a seperate issue from blunted villi.

For example....Enterolab tests IgA antibodies for yeast and egg in the stool....I have never read anywhere of a link between these foods and blunted villi consistent with Celiac Disease.

I have heard of casein causing blunted villi in some cases but I dont think its a common occurance.

Here are a couple

Open Original Shared Link

pBiopsy.htmOpen Original Shared Link

[2kids4me]

Where does it say that any food intolerance can cause blunted villi?? I have never read that on Enterolab's site (or anywhere else).

Please read my other post in this topic. I have reposted part of it here:

The site is about the histopathology of biopsies. Other things cause villi blunting / celiac is a result of immune attack and has lymphocytes etc / allergy to foods has villi blunting BUT eosinophils predominate.

On biopsy, however, some other conditions can mimic aspects of celiac disease Some of these conditions and useful differential diagnostic points are summarized here:

- Autoimmune enteropathy: crypt injury/destruction; anti-enterocyte antibodies in 50% of cases. Onset usually in the first 6 months after birth.

-Tropical sprue: lack of antiendomysial antibodies; response to antibiotic and folate therapy.

-Common variable immunodeficiency: paucity or absence of plasma cells; marked lymphoid nodular hyperplasia; Giardia infection common.

-Infectious (usually viral) enteritis: normal IEL counts.

-Food protein intolerance (eggs, cow milk, etc.): increased eosinophils; other allergic manifestation (asthma, atopy); response to elimination diets.

-Development of lymphoma: atypical lymphoid infiltrate; high index of suspicion; imaging studies that demonstrate mass lesions.