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What conditions other than Celiac can cause villi blunting?

Posted by sillysongbird

My gastroenterologist found blunted villi during my latest endoscopy and colonoscopy procedure, but the blood test was negative for Celiac. Is there anything else that can cause villi blunting or villous atrophy?
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Hi Sillysongbird

I came across your question today. I have recently had an endoscopy and duodenal biopsy as part of investigation for iron defiency anaemia.

It is difficult to give you specific advice without knowing your full history and results of all your investigations. I think you need to returna nd ask you gastroenterologist this question.

The histology of duodenal biopsies is very complex and technical.

As to causes of blunting of villi, I found this comment buried in an artical about duodenal biopsies (which illustrates the complexity of the subject): "Villi may be blunted and shortened or appear atrophic when the lamina propria is infiltrated by macrophages, such as in Whipple's disease or in M avium intracellulare infections, or by a dense infiltrate of plasma cells and centrocyteรข??like lymphocytes or small, pleomorphic lymphocytes. In these cases, the overlying epithelium is usually intact, crypts are spared and the IEL count is normal."

source is  

whipples disease is extremely rare.

see this article about tests for coeliac disease:


it is also important to note that: " The coeliac lesion occurs predominantly in the proximal small intestine, reflecting the distribution of gluten encounter. Changes may be mild and patchy and for this reason it is recommended that multiple (>4) biopsies are taken from separate sites, usually by upper gastrointestinal endoscopy from the second part of the duodenum. The classic histological features are intraepithelial lymphocytosis, chronic immune cell infiltration of the lamina propria, loss of villous height (villous atrophy), and crypt hyperplasia."

you may need further blood tests (there are 2 tests currently used regularly for coeliac disease and possible repeat biopsies.

It seems sensible to have a trial of a gluten free diet, but really you need a definitive answer. Avoiding gluten for life is quite an undertaking and there may be another cause for your symptoms. Or you may be a latent early coeliac.

Please go back and see your gastroeneterologist. Good luck. David 

Thanks Amanda! I've been on a gluten-free diet for a couple of weeks now and from what I can tell, it's been a good change for me. One question: After you go gluten-free, if you lapse and have something with gluten in it, is is possible for the reacting to eating it to be more severe than is was before you were gluten-free? I ask because I ate pizza the other night after being gluten-free for a couple of weeks and I felt worse than I have felt in a long time. I was just wondering if increased sensitivity was normal or just coincidence for someone who  was gluten-free. Any ideas?

You might need to act as though you are a celiac and try a gluten free diet.

I mention this because we are now finding that many people who actually have problems with gluten are testing negative for celiac. It's called non-mediated gluten reactivity.

 My daughter had terrible allergies and issues was tested for celiac and it came back negative.

As a holistic nutrionist I suggested we all do a gluten free diet anyway to test for reactivity and all of her symptoms and some we didn't even know were related disappeared.

Go gluten free for 30 days and see if there is a difference. A great blog on this specific issue can be found when you google Wheat Belly, it's a book written by a Cardiovascular Doctor who has studied the link between gluten and various illnesses.

In health,



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