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  • Scott Adams
    Scott Adams

    What Causes Villous Atrophy Besides Celiac Disease?

    Reviewed and edited by a celiac disease expert.

    Villous atrophy occurs when your intestinal villi, the fingerlike protrusions in your intestine, become damaged. Villous atrophy is a common sign of celiac disease, but it's not the only cause.

    What Causes Villous Atrophy Besides Celiac Disease? - Inflamed mucous layer of the intestinal villi depicting celiac disease. Image: CC BY-SA 4.0--www.scientificanimations.com
    Caption: Inflamed mucous layer of the intestinal villi depicting celiac disease. Image: CC BY-SA 4.0--www.scientificanimations.com

    Celiac.com 06/01/2021 - Villous atrophy not caused by celiac disease is called "non-celiac enteropathy." In many cases, the symptoms mirror the classic symptoms of celiac disease: diarrhea, weight loss, abdominal pain, and fatigue.

    Spotting the difference between celiac disease and non-celiac enteropathy can be challenging. That's why physicians recommend celiac disease blood tests, which are used to find adverse immune reactions to the gluten protein in the foods you eat.

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    Just as it's possible to have damaged villi without celiac disease, it's possible to have celiac disease, and villi damage, even with negative blood antibody tests. 

    People with celiac disease usually improve on a gluten-free diet. While some may not, many folks with non-celiac enteropathy do not respond to a gluten-free diet.

    People who do not see symptom improvement on a gluten-free diet may need to consider alternative causes for their symptoms and villous atrophy.

    Non-Celiac Causes of Villous Atrophy

    Non-celiac causes of villous atrophy include:

    Benicar (olmesartan)
    In some patients, taking this blood pressure medication leads to villous atrophy combined with diarrhea and weight loss. The U.S. Food and Drug Administration issued a warning about this in 2013.

    Common Variable Immune Deficiency, or CVID
    CVID is a condition that leaves people vulnerable to recurrent infections. 

    Crohn's disease
    Villous atrophy is unusual in Crohn's disease, but can happen.

    Lymphoma
    One study found two different types of lymphoma could cause villous atrophy: small intestinal T-cell lymphoma, and enteropathy-associated T-cell lymphoma. Enteropathy-associated T-cell lymphoma is closely linked to celiac disease.

    Casein/Cow's Milk Intolerance
    Research has shown that flattened villi can also be caused by casein intolerance. For more info see "Mucosal reactivity to cow's milk protein in C(o)eliac disease," which states "A mucosal inflammatory response similar to that elicited by gluten was produced by CM (Cows Milk) protein in about 50% of the patients with coeliac disease. Casein, in particular, seems to be involved in this reaction."

    Certain Drugs
    Drugs that suppress your immune system (such as Imuran and CellCept), the antibiotic neomycin, and the anti-inflammatory medication Colcrys, also have been linked to reports of medication-induced villous atrophy.

    Small intestine Bacterial Overgrowth, or SIBO
    Symptoms of SIBO can mimic those of celiac disease.
    Other possible causes of villous atrophy, including infection with parasites or with the ulcer-causing bacteria Helicobacter pylori, also have been reported.

    Thiamine Deficiency and/or Beri Beri
    Both can cause thinning of the villi, leading to both casein/lactose intolerance and in time possibly a celiac disease or non-celiac gluten sensitivity (NCGS) diagnosis.

    Not all Villous Atrophy is From Celiac Disease
    Most, but not all, cases of villous atrophy are caused by celiac disease. Patients with negative blood test, who do not see symptoms improve on a gluten-free diet, should consult with a doctor about other possible causes of villous atrophy.



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    Posterboy

    Scott,

    Thank you for that article.

    But I think you should update it (the article) to include both a Thiamine Deficiency and/or Beri Beri and a Casein/Lactose Intolerance.

    This was just a quick google search.....but the literature clearly shows that a Casein Intolerance is happening in approx. 50% of Celiac's not responding to a gluten free diet alone.

    Entitled "Mucosal reactivity to cow's milk protein in C(o)eliac disease"

    Open Original Shared Link

    quoting

    "A mucosal inflammatory response similar to that elicited by gluten was produced by CM (Cows Milk) protein in about 50% of the patients with coeliac disease. Casein, in particular, seems to be involved in this reaction."

    Not surprising this research is 12+ years old.....and nobody has stringed all the pearls together until now.

    Verified recently in Children....published less than a year ago.

    Entitled "Milk Protein-Induced Villous Atrophy and Elevated Serologies in Four Children with Celiac Disease on a Gluten-Free Diet"

    Open Original Shared Link

    Quoting their Conclusion.

    "In summary, we describe for the first time four cases of pedi-atric celiac disease asymptomatic while on a GFD but with persistent celiac autoimmunity and villous atrophy with complete response to elimination of CM protein.  All four patients had a prompt re-sponse to a milk and gluten-free diet with full normalization of celiac serologies. More impressive, two have undergone repeat EGD with biopsies on the CM-GFD so far and both had complete histologic recovery. This suggests that a child with celiac disease whose celiac disease-specific serology and duodenal mucosa changes do not re-spond to a highly controlled, strict GFD should undergo a trial of a CM (Cows MIlk) and a GFD prior to being labeled refractory celiac disease"

    For other's who might be following this article......I know Scott already knows this.

    Here is the the article about how a Thiamine Deficiency and/or Beri Beri can Thin Villi leading to both Lactose Intolerance (Casein Intolerance really) and in time a Celiac disease or NCGS diagnosis if it has not been going on long enough to trigger complete Villus Atrophy.

    I have studied it long enough that I understand what is happening....the Lord being my help!

    It is like stringing the Pearls of Knowledge into a Necklace.....together each Pearl of knowledge/wisdom is pretty on it's own.....but you don't get a complete picture (Necklace) until you string them all together!

    I hope this is helpful but it is not medical advice.

    Posterboy,

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    Scott Adams

    I updated this...thank you!

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    Posterboy

    Scott Et Al,

    I just wanted to update this article with a better resource.

    Here is the thread started on Lactose Intolerance as a possible cause for Refractory Celiac disease.

    Here is the original research about Cows Milk Protein (especially Casein) that can trigger Anti-tissue antibodies in gluten free Celiac's.

    Entitled "Anti-tissue transglutaminase antibodies not related to gluten intake" from Cows Milk Protein....Instead

    Open Original Shared Link

    quoting their Conclusion(s).....so you won't have to go back and read the whole abstract.

    "Conclusions: CMP ingestion after an exclusion diet can induce an increase in anti-tTG in some coeliac subjects. CMP (IE Casein) can produce this immune response (even) if there were no gluten transgressions....."

    As always I hope this is helpful but it is not medical advice.

    I hope this helps many people still trying to find the cause of their elevated Gluten Antibodies when they know it is not related to Cross Contamination issues or a Strict Adherence to a Gluten Free diet.

    YOU should also definitely remove dairy/lactose/Casein(s) from your diet to see if your Gluten Antibodies don't also get better too!

    Posterboy,

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    CMCM

    I find this kind of information useful and interesting.  As an infant I could not tolerate cow's milk at all, and eventually I did better (but not great) on goat's milk.  But I always had trouble with dairy and I never wanted to drink milk, eat ice cream, cheese, etc.  I just knew to stay away from it.  My mother wasn't diagnosed with celiac until I was about 16, but interestingly, she had absolutely zero issues with dairy.  Even after she got her celiac diagnosis, I still thought I wasn't affected by gluten and figured my problem was dairy.  Wrong!  It was both!  When I did Enterolab testing for celiac/gluten, I also got a test for dairy sensitivity (specifically, casein intolerance).  I was positive for both, and Enterolab claimed casein intolerance could do just as much damage potentially as gluten. They strongly advised avoiding all dairy as well as gluten.  I've tried the lactose pills, but I'm pretty sure that lactose intolerance isn't my problem...it's casein.

    Edited by CMCM
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    Guest Lucille Cholerton

    Posted

    Very interesting and enlightening. 

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    CharlesBronson

    So if I had a positive antibody blood test, I definitely have celiac and there's no chance it could be non-celiac enteropathy? 

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    Scott Adams

    It's possible, but not likely, especially if you also had a positive blood test for celiac disease.

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    CharlesBronson
    2 hours ago, Scott Adams said:

    It's possible, but not likely, especially if you also had a positive blood test for celiac disease.

    Thanks so much for replying! Yes, my antibody test was through the roof, unfortunately. And I had total villas atrophy. 

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    Scott Adams

    I seriously doubt your diagnosis was incorrect, but I have seen many people later question their original diagnosis, do a gluten challenge, only to find that they really do have an issue with gluten. 

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    Kathy8183
    On 6/2/2021 at 6:39 PM, Posterboy said:

    Scott Et Al,

    I just wanted to update this article with a better resource.

    Here is the thread started on Lactose Intolerance as a possible cause for Refractory Celiac disease.

    Here is the original research about Cows Milk Protein (especially Casein) that can trigger Anti-tissue antibodies in gluten free Celiac's.

    Entitled "Anti-tissue transglutaminase antibodies not related to gluten intake" from Cows Milk Protein....Instead

    Open Original Shared Link

    quoting their Conclusion(s).....so you won't have to go back and read the whole abstract.

    "Conclusions: CMP ingestion after an exclusion diet can induce an increase in anti-tTG in some coeliac subjects. CMP (IE Casein) can produce this immune response (even) if there were no gluten transgressions....."

    As always I hope this is helpful but it is not medical advice.

    I hope this helps many people still trying to find the cause of their elevated Gluten Antibodies when they know it is not related to Cross Contamination issues or a Strict Adherence to a Gluten Free diet.

    YOU should also definitely remove dairy/lactose/Casein(s) from your diet to see if your Gluten Antibodies don't also get better too!

    Posterboy,

    This is such valuable information I cannot thank you enough. It quite possibly explains my antibodies dropped from over 250 at diagnosis to over 59 a year later on a strict gluten-free diet. I gave up lactose because I react so strongly to it since my celiac diagnosis but I have continued to consume cows milk even more than before for it's convenient source of calcium and protein and no noticeable adverse reactions. I'm interested in seeing results of a retest of my antibodies in 6 months while consuming zero milk products. This might be the final mystery to my improved celiac test results yet that lingering over 59 result I still have. Quite an eye opening article here. Thanks! 

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    JB007

    There is also a condition called chronic athrophic deundenits. The only way to tell the difference between the two is there is malabsorption in celiac disease

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    trents
    On 4/12/2023 at 7:23 AM, Kathy8183 said:

    This is such valuable information I cannot thank you enough. It quite possibly explains my antibodies dropped from over 250 at diagnosis to over 59 a year later on a strict gluten-free diet. I gave up lactose because I react so strongly to it since my celiac diagnosis but I have continued to consume cows milk even more than before for it's convenient source of calcium and protein and no noticeable adverse reactions. I'm interested in seeing results of a retest of my antibodies in 6 months while consuming zero milk products. This might be the final mystery to my improved celiac test results yet that lingering over 59 result I still have. Quite an eye opening article here. Thanks! 

    I realize I am responding to an old post here but this doesn't make any sense. You can't have give up lactose while at the same time "continued to consume cows milk even more than before". Lactose is the sugar component of cow's milk. Unless you treat it with Lactaid or buy it already treated (and the poster makes no mention of doing so) you are just consuming more lactose when you consume more cow's milk.

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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.


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