Non-celiac enteropathies (NCE)

Non-celiac enteropathies (NCE) are a group of disorders that can cause damage to the small intestine, including villous atrophy. The small intestine contains tiny, finger-like structures called villi that help the body absorb nutrients from food.

When the villi become damaged or flattened, the body may have difficulty absorbing nutrients. This can lead to diarrhea, weight loss, nutritional deficiencies and other symptoms.

Celiac disease is one cause of intestinal villous atrophy, but it is not the only cause. Non-celiac enteropathies are conditions that cause similar intestinal changes without the underlying gluten-related immune response of celiac disease.

Some non-celiac enteropathies are related to the immune system, infections, medications or other intestinal conditions. Identifying the specific cause is important because treatment varies depending on the underlying condition.

Symptoms of non-celiac enteropathies can vary depending on the underlying cause and the severity of intestinal damage.

Common symptoms include:

• Chronic or persistent diarrhea

• Abdominal pain or discomfort

• Bloating

• Unexplained weight loss

• Nausea

• Fatigue 

• Weakness

• Changes in bowel habits

• Nutritional deficiencies

• Symptoms related to poor absorption of vitamins, minerals or other nutrients

• Difficulty concentrating, sometimes described as “brain fog”

Some people may have few symptoms despite having significant changes in the small intestine.

Non-celiac enteropathies can have many different causes. Some of the conditions that may cause intestinal villous atrophy or similar changes include:

• Autoimmune enteropathy

• Common variable immunodeficiency

• Certain intestinal infections, including giardiasis 

• Medication-related intestinal injury

• Crohn's disease and other inflammatory conditions

• Tropical sprue

• Small intestinal bacterial overgrowth 

• Certain immune or malignant conditions

• Other less common intestinal disorders

A detailed medical history, medication review, travel history and evaluation of other health conditions can help identify the underlying cause.

Not every condition that causes intestinal symptoms or mild changes in the small intestine is considered a non-celiac enteropathy. Your care team will determine which conditions may be contributing to your symptoms and test results. 

Diagnosing non-celiac enteropathy can be complex because several conditions can cause similar symptoms and changes in the small intestine.

Diagnosis typically begins with a gastroenterologist who reviews your symptoms, medical history, medications, diet and previous test results.

Your care team may use:

• Blood tests for celiac disease and other conditions 

• Total immunoglobulin A testing

• Genetic testing for celiac-associated HLA-DQ2 and HLA-DQ8 variants

• Stool tests for infections or other causes of diarrhea

• Upper gastrointestinal endoscopy 

• Biopsies of the small intestine

• Detailed review of biopsy results by an experienced gastrointestinal pathologist

• Medication and supplement review

• Additional testing based on your symptoms and medical history 

The finding of villous atrophy does not by itself confirm celiac disease. Your gastroenterologist will consider your blood test results, biopsy findings, symptoms, diet, medical history and other possible causes.

If celiac disease testing is negative but the small intestine shows villous atrophy, additional evaluation may be needed to distinguish a non-celiac enteropathy from seronegative celiac disease, a less common form of celiac disease in which standard antibody testing is negative.

Treatment for non-celiac enteropathy depends on the underlying cause. There is no single treatment or diet that works for every type of non-celiac enteropathy.

Once the cause has been identified, treatment may include:

• Treating an underlying infection

• Changing or stopping a medication that is causing intestinal injury 

• Treating an autoimmune or inflammatory condition

• Managing an underlying immune system disorder

• Providing nutritional support

• Treating vitamin and mineral deficiencies 

• Managing diarrhea, weight loss or other symptoms

A gluten-free diet may be appropriate for some patients, but it is not a treatment for every non-celiac enteropathy. An accurate diagnosis helps ensure that treatment is directed at the underlying cause.

Nutritional support

Damage to the small intestine can interfere with the absorption of nutrients. Depending on the type and severity of enteropathy, your care team may evaluate you for deficiencies in iron, vitamin B12, folate, vitamin D and other nutrients. 

Treatment may include dietary changes, oral supplements or other forms of nutritional support.

A registered dietitian may work with your care team to help you maintain adequate nutrition and manage dietary changes related to your condition.

Monitoring and follow-up

Non-celiac enteropathies can require ongoing monitoring, particularly when intestinal damage has caused malabsorption or nutritional deficiencies. 

Your care team may monitor:

• Symptoms and bowel habits

• Weight and nutritional status

• Vitamin and mineral levels 

• Response to treatment

• Blood test results

• The underlying condition causing the enteropathy

Additional endoscopy or small intestine biopsies may be recommended in some cases to determine whether the intestinal lining has improved with treatment. 

Non-celiac enteropathies can be challenging to diagnose because different conditions can cause similar symptoms and microscopic changes in the small intestine. Correctly identifying the underlying cause is important because treatment can vary significantly from one condition to another.

UC Health's gastroenterologists have expertise in celiac disease and small bowel disorders and use a comprehensive approach to evaluating patients with complex intestinal conditions. Our team can combine laboratory testing, advanced endoscopy, small intestine biopsies and clinical evaluation to help distinguish non-celiac enteropathies from celiac disease and other conditions.

When appropriate, patients can also receive nutritional support and care for complications related to malabsorption.

If you have persistent diarrhea, unexplained weight loss, nutritional deficiencies or other symptoms associated with intestinal damage, UC Health's digestive disease specialists can help determine the cause and develop an individualized treatment plan. 

Schedule an appointment to receive an evaluation and learn more about your treatment options.

Call 513-475-7505.