Gluten- and non-gluten-dependent non-atrophic lesions: the clinician and the pathologist viewpoint

Non-atrophic lesions of the small bowel mucosa are characterised by minimal intestinal lesions with an increased number of intraepithelial lymphocytes (IEL), with or without crypt hyperplasia and in presence of a normal architecture of intestinal villi. Minimal intestinal lesions, though non-specific for coeliac disease (CD), are included in the wide spectrum of gluten-dependent histological damage and they can be an expression of potential CD. However, they can be a sign of many disorders other than gluten-sensitive enteropathy. Therefore, it is important to differentiate patients with gluten-dependent intestinal damage from those with non gluten- dependent intestinal lesions in order to plan the correct treatment and follow-up.