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Minimal Lesions of the Small Intestinal Mucosa: More than Morphology

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Abstract

Minimal lesions of the small bowel are mucosal changes characterized by an increased number of intraepithelial lymphocytes (with or without crypt hyperplasia) and normal villous architecture. Such changes are associated with a wide spectrum of conditions, ranging from food intolerances to infections, and from drugs to immune diseases, with different clinical profiles and manifestations, which complicates the formulation of a differential diagnosis. Patient history, symptom evaluation, and histopathology are the diagnostic features needed to establish a correct diagnosis. Physicians should assist pathologists in formulating a precise morphological evaluation by taking well-oriented small intestinal biopsies and collecting informative clinical findings that inform histopathology. In this current clinical controversy, the authors provide the reader with an appraisal of the small intestine minimal lesions through a careful analysis of the major conditions (e.g., celiac disease and other non-celiac disorders) responsible for such changes and their differential diagnosis. Also, we acknowledge that some of the diseases detailed in this article may progress from an early minimal lesion to overt mucosal atrophy. Thus, the timing of the diagnosis is of paramount importance.

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Author notes

  1. Umberto Volta and Giacomo Caio contributed equally to this work.

Authors and Affiliations

  1. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Umberto Volta

  2. Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Ferrara, Italy

    Giacomo Caio, Caterina Ghirardi, Lisa Lungaro & Roberto De Giorgio

  3. Celiac Center and Mucosal Immunology and Biology Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Giacomo Caio

  4. Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy

    Pasquale Mansueto

  5. Unit of Internal Medicine, “V. Cervello” Hospital, Ospedali Riuniti “Villa Sofia-Cervello”, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy

    Antonio Carroccio

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  1. Umberto Volta
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Volta, U., Caio, G., Ghirardi, C. et al. Minimal Lesions of the Small Intestinal Mucosa: More than Morphology. Dig Dis Sci 65, 2761–2768 (2020). https://doi.org/10.1007/s10620-020-06571-1

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