Severe malabsorption due to refractory celiac disease complicated by extensive gastric heterotopia of the jejunum

The American Journal of Surgical Pathology
Barbara TriblAndreas Chott


Refractory celiac disease denotes that patients considered to have celiac disease fail to respond histologically to treatment with a gluten-free diet. Among several causes of nonresponsiveness, enteropathy-type T-cell lymphoma is most important because of its almost invariably rapid lethal outcome. We present the case of a 44-year-old patient with refractory celiac disease complicated by unusually severe malabsorption. Repeated duodenal biopsies disclosed normal and slightly shortened villi, focal crypt hypertrophy, and a moderate increase of intraepithelial lymphocytes consistent with celiac disease, but unable to explain the severe malabsorption. To rule out cryptic lymphoma, push enteroscopy was done providing 21 biopsies taken along the entire jejunum. Surprisingly, about 70% of the biopsies were composed of gastric glands covered by nonabsorptive-type, strongly periodic acid-Schiff-positive surface epithelium and showed a villous architecture. Alternating with the gastric mucosa, there were areas of flat mucosa with elongated crypts and occasional erosions. Irrespective of the type of surface epithelium, intraepithelial lymphocytes were increased with counts up to 80/100 epithelial cells. Despite harboring an aberrant immu...Continue Reading


Sep 1, 1994·Human Immunology·K E LundinE Thorsby
Jul 12, 1997·Lancet·G R CorazzaG Gasbarrini
Mar 13, 1998·Gastroenterology·C CellierN Cerf-Bensussan
Nov 12, 1998·The American Journal of Pathology·A ChottH K Müller-Hermelink
Oct 19, 1999·European Journal of Gastroenterology & Hepatology·G OberhuberH Vogelsang
Apr 1, 2000·Pediatric and Developmental Pathology : the Official Journal of the Society for Pediatric Pathology and the Paediatric Pathology Society·M P LambertC Bethel
Jul 13, 2000·Gastroenterology·B M Ryan, D Kelleher

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Mar 4, 2010·Archives of Pathology & Laboratory Medicine·Giovanni De Petris, Stanley T Leung

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