Jejunal Villous Atrophy – Causes, Symptoms & Treatment

What is Jejunal Villous Atrophy?

Jejunal villous atrophy describes the pathological reduction or complete loss of intestinal villi in the jejunum, the middle section of the small intestine. The intestinal villi are finger-like projections of the intestinal mucosa that dramatically increase the absorptive surface area of the small intestine, making them essential for the uptake of nutrients, vitamins, and minerals from food. When villous atrophy occurs, this absorptive capacity is significantly reduced, leading to malabsorption.

Causes

Jejunal villous atrophy can result from a variety of diseases and triggers:

• Celiac disease (gluten-sensitive enteropathy): The most common cause. An immune-mediated reaction to the protein gluten leads to chronic inflammation and progressive destruction of the intestinal villi.
• Tropical sprue: An infectious or nutrition-related condition found in tropical regions that causes similar mucosal changes.
• Autoimmune enteropathy: A rare condition in which the immune system attacks the intestinal lining.
• Medications: Certain drugs such as methotrexate or nonsteroidal anti-inflammatory drugs (NSAIDs) can damage the intestinal mucosa.
• Infections: Parasitic infections (e.g., Giardia lamblia) or severe bacterial infections of the small intestine.
• Crohn's disease: A chronic inflammatory bowel disease that can also affect the jejunum.
• Common Variable Immunodeficiency (CVID): An immune deficiency disorder that may be associated with villous atrophy.

Symptoms

Since nutrient absorption in the jejunum is impaired, jejunal villous atrophy manifests through a wide range of symptoms:

• Chronic diarrhea, often fatty and foul-smelling (steatorrhea)
• Abdominal pain, bloating, and a feeling of fullness
• Weight loss and malnutrition
• Nutritional deficiencies: iron, folate, vitamin B12, calcium, and vitamin D deficiency
• Anemia
• Fatigue, exhaustion, and reduced performance
• In children: failure to thrive and growth retardation
• Osteoporosis due to long-term calcium deficiency

Diagnosis

Diagnosing jejunal villous atrophy requires a combination of clinical evaluation, serological testing, and histological examination:

Serological Tests

When celiac disease is suspected, specific antibodies are measured in the blood, particularly anti-tissue transglutaminase IgA antibodies and anti-endomysial antibodies.

Endoscopy and Biopsy

The most important diagnostic procedure is upper gastrointestinal endoscopy (esophagogastroduodenoscopy, EGD) with collection of tissue samples (biopsies) from the jejunum or distal duodenum. The degree of villous atrophy is assessed histologically using the Marsh classification (Marsh 0 to Marsh 3c), with Marsh 3 indicating complete villous atrophy.

Laboratory Tests

Blood tests for nutritional deficiencies (iron, ferritin, folate, vitamin B12, calcium, vitamin D) and inflammatory markers complement the diagnostic workup.

Treatment

Treatment is directed at the underlying cause:

Gluten-Free Diet for Celiac Disease

In celiac disease, a strict and lifelong gluten-free diet is the only effective therapy. It typically leads to complete regeneration of the intestinal villi within months to years.

Treatment of the Underlying Condition

For other causes, treating the primary disease takes priority -- for example, antiparasitic agents for giardiasis or immunosuppressants for autoimmune enteropathy.

Nutritional Supplementation

Existing deficiencies are addressed through targeted dietary supplements or intravenous infusions, such as iron, folate, vitamin B12, calcium, and vitamin D.

Nutritional Therapy

Dietary counseling by qualified professionals supports the rehabilitation of the intestinal mucosa and ensures adequate nutrient intake.

References

1. Ludvigsson JF, et al. - Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut. 2014;63(8):1210-1228.
2. Rubio-Tapia A, et al. - ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology. 2013;108(5):656-676.
3. World Health Organization (WHO) - Chronic diseases and health promotion: Celiac disease. Available at: https://www.who.int