Enteropathy

Enteropathy is a broad term for diseases that affect the lining of the intestines, most often the small intestine, resulting in impaired absorption of nutrients. It encompasses a range of etiologies, including immune-mediated, infectious, inflammatory, nutritional, and drug- or toxin-induced conditions. The common feature is mucosal injury that disrupts the normal architecture and absorptive surface.

Common causes and examples include celiac disease, tropical sprue, Crohn disease with small-bowel involvement, autoimmune enteropathy, infectious enteritis, and graft-versus-host disease after transplantation. Secondary or associated factors such as pancreatic exocrine insufficiency, bile acid malabsorption, and chronic gut inflammation can also lead to enteropathy. The pathophysiology often involves villous atrophy or crypt hyperplasia with varying degrees of inflammatory cell infiltration.

Clinical presentation typically centers on chronic diarrhea, sometimes with steatorrhea, weight loss, bloating, abdominal pain, and signs of nutrient deficiencies such as anemia or electrolyte disturbances. Diagnosis relies on a combination of clinical suspicion, laboratory tests (including nutrient levels and serologies for specific diseases), imaging or endoscopy, and most directly, small-bowel biopsy showing mucosal changes such as villous blunting and crypt hyperplasia, with varying inflammatory patterns.

Management is etiologiespecific and may include dietary modification (for example, a gluten-free diet in celiac disease), antibiotics for certain infections, immunosuppressants or steroids for autoimmune enteropathy, and supportive care with nutritional rehabilitation. Pancreatic enzyme replacement or bile acid therapies may be used for non-mucosal causes. Prognosis varies by underlying condition; dietary treatment often yields substantial improvement in celiac disease, while other causes may be chronic or progressive if not adequately addressed.