{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T07:38:41Z","timestamp":1767166721453,"version":"build-2238731810"},"reference-count":35,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Biopsies from the second part of the duodenum are routinely performed in patients with unintentional weight loss. When villous atrophy and an increased intraepithelial lymphocytosis are detected, the commonest cause of it is coeliac disease. Severe villous atrophy with increased intraepithelial lymphocytosis (Marsh IIIc) is highly specific for coeliac disease. However, coeliac disease with this presentation is very rare. Milder abnormalities such as Marsh I-II (microscopic enteritis) and Marsh IIIa are not specific for coeliac disease and could occur in other conditions like those listed in the discussion. We present the case of a 74-year-old woman who, after being diagnosed with seronegative coeliac disease, failed to improve on a gluten-free diet. We discuss the differential diagnosis of coeliac disease and the possible alternative causes for villous blunting, paying particular attention to the diagnosis of small intestinal bacterial overgrowth.<\/jats:p>","DOI":"10.1136\/bcr-2013-201963","type":"journal-article","created":{"date-parts":[[2014,2,10]],"date-time":"2014-02-10T06:23:12Z","timestamp":1392013392000},"page":"bcr2013201963","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["All that glitters is not always gold"],"prefix":"10.1136","volume":"2014","author":[{"given":"E","family":"Harrison","sequence":"first","affiliation":[{"name":"Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Hayes","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Salford Royal NHS Foundation Trust, Salford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Lal","sequence":"additional","affiliation":[{"name":"Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,2,10]]},"reference":[{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-230X-9-19"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.2","doi-asserted-by":"publisher","DOI":"10.1097\/00042737-200304000-00012"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.3","doi-asserted-by":"publisher","DOI":"10.1136\/gut.52.7.960"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.4","first-page":"134","article-title":"Coeliac disease: clinical presentations, correlations of dietary compliance, symptomatic response and repeat biopsy findings","volume":"61","author":"McElvaney","year":"1992","journal-title":"Ulster Med J"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.5","doi-asserted-by":"crossref","first-page":"466","DOI":"10.4321\/S1130-01082010000800002","article-title":"Coeliac disease: clinical features in adult populations","volume":"102","author":"Fernandez","year":"2010","journal-title":"Rev Esp Enferm Dig"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.6","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/j.1651-2227.2008.01085.x","article-title":"Serum zinc in small children with coeliac disease","volume":"98","author":"Hogberg","year":"2009","journal-title":"Acta Paediatr"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.7","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e318216f2e5"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.8","doi-asserted-by":"publisher","DOI":"10.1159\/000024438"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.9","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1182\/blood.V90.2.893","article-title":"Prevalence of selective IgA deficiency in Spain: more than we thought","volume":"90","author":"Pereira","year":"1997","journal-title":"Blood"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.10","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e31824b2277"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.11","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.79"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.12","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.171"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2010.06.026"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.14","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3181677d6e"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.15","doi-asserted-by":"publisher","DOI":"10.1136\/gut.31.1.111"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.983_f.x"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.17","doi-asserted-by":"publisher","DOI":"10.1080\/003655202753387329"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.18","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcq076"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.19","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-5-200709040-00003"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2010.02.019"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0198-8859(03)00027-2"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04938.x"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.23","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2011-0572-RA"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.24","first-page":"277","article-title":"Chronic morpho-functional damage as a consequence of transient ischemia\/reperfusion injury of the small bowel","volume":"25","author":"Morini","year":"2010","journal-title":"Histol Histopathol"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.25","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e3181557e67"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.26","doi-asserted-by":"crossref","first-page":"264","DOI":"10.5858\/134.2.264","article-title":"Small intestinal bacterial overgrowth: histopathologic features and clinical correlates in an underrecognized entity","volume":"134","author":"Lappinga","year":"2010","journal-title":"Arch Pathol Lab Med"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.2010.02419.x"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.28","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/20.1.29"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.29","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-006-1884-0"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.30","first-page":"500","article-title":"Usefulness of faecal elastase-1 assay in monitoring pancreatic function in childhood coeliac disease","volume":"30","author":"Carroccio","year":"1998","journal-title":"Ital J Gastroenterol Hepatol"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.31","doi-asserted-by":"publisher","DOI":"10.1097\/00005176-200303000-00018"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.32","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2011-100011"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.33","doi-asserted-by":"publisher","DOI":"10.1159\/000116777"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.34","first-page":"1328","article-title":"Fecal calprotectin concentration in children affected by SIBO","volume":"15","author":"Fundaro","year":"2011","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025082700311938000_2014.feb10_1.bcr2013201963.35","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1080\/00365520601173632","article-title":"Faecal calprotectin concentrations in untreated coeliac patients","volume":"42","author":"Montalto","year":"2007","journal-title":"Scand J Gastroenterol"}],"updated-by":[{"DOI":"10.1136\/bcr-2013-201963.cor1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2014,2,20]],"date-time":"2014-02-20T00:00:00Z","timestamp":1392854400000}}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2013-201963","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:31:29Z","timestamp":1756279889000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2013-201963"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2,10]]},"references-count":35,"alternative-id":["10.1136\/bcr-2013-201963"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2013-201963","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2,10]]}}}