Non-celiac villous atrophy: More confusion or a new syndrome? Atrofia vellositaria sin enfermedad celíaca: ¿un nuevo síndrome o más confusión?

It is not unusual for clinicians, particularly for those working in gastroenterology, to find intestinal villus atrophy (IVA) in duodenum biopsies from patients treated with chronic diarrhoea. In most cases, this finding rules out the existence of coeliac disease (CD)1. CD is an autoimmune disease that mostly develops in genetically predisposed subjects carrying HLA-DQ2/DQ82. To obtain a definitive diagnosis of CD, it is necessary not just to have compatible clinical data, but also to assess other findings, among them: the presence of positive serology, mainly through the detection of IgA or IgG anti-transglutaminase antibodies, or, in cases with negative serology or border levels, the presence of antiendomysial IgA antibodies; a compatible histology, standardised by means of the MARSH Classification3; and a clinical response to a glutenfree diet2. The new immunohistochemistry and flow cytometry techniques that make it possible to characterise the predominant lymphocyte subpopulations located in the intestinal lamina propria have not been available for that long. Thanks to these techniques, we have been able to establish how the increase of TCR gammadelta lymphocytes and the decrease of NK CD3+/CD7lymphocytes are findings specifically associated with CD4, thus facilitating the differential diagnosis of other diseases. These techniques are not available for every medical centre. In spite of the aforesaid, CD diagnosis is not always easy to obtain, since there is a small group of patients who have IVA and are responsive to a gluten-free diet but whose antibodies are negative, resulting in the creation of the increasingly widespread seronegative CD concept. Even though CD is the most frequent cause of IVA1, there are other less frequent processes that may trigger it (table 1), widening a range of diagnostic possibilities before this histological finding