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intestinal villous atrophy

Monday 15 December 2003

atrophic villi, flat villi


- atrophic and flat intestinal villi

Types (according to extension)

- focal villous atrophy
- diffuse villous atrophy

Types (according to crypt appearance)

- hyperplastic villous atrophy
- hypoplastic villous atrophy (with crypt hyperplasia)

Types (according to inflammation)

- villous atrophy with mucosal inflammation
- villous atrophy without mucosal inflammation


- hyperplastic villous atrophy (with crypt hyperplasia)

  • coeliac disease (gluten-senstive enteropathy)
  • chronic trauma
  • small bowell transplanted as an artificial oesopahgus
  • urinary ileal conduits
  • intestinal mucosal inflammation
    • adjacent to intestinal ulcers
    • intestinal anastomosis
  • glucagonoma
  • extensive small bowell resections
  • primary ileal villous atrophy
    • microscopic colitis atrophy (9391260)
    • intestinal microvillous atrophy
    • mitochondrial cytopathy (mitochondrial respiratory chain anomaly)

- hypoplastic villous atrophy (without crypt hyperplasia)

  • malnutrition (kwashiorkor)
  • malignancy
  • untreated pernicious anemia
  • Paneth cell deficiency
  • hypopituitarism
  • celiac disease unresponsive to gluten-free diet
  • tropical sprue
  • radiation-associated ischemia
  • drug-induced villous atrophy


- villous atrophy with mucosal inflammation (chorionic inflammation)

  • celiac disease
  • severe alimentary intolerance
  • congenital Crohn disease
  • autoimmune enteropathy
  • various enterocolitis
  • immunodeficiency syndromes
    • selective IgA deficiency

Marsh classification of intestinal villous atrophy

Types Type 0 Type 1 Type 2 Type 3a Type 3b Type 3c
IEL @<@40 >40 >40 >40 >40 >40
Crypts Normal Normal Hypertrophic Hypertrophic Hypertrophic Hypertrophic
Villi Normal Normal Normal Mild atrophy Marked atrophy Absent

NB: IEL, IntraEpithelial Lymphocytes (per 100 epithelial cells)

See also

- villous anomalies
- intestinal lesions


- Ludvigsson JF, Brandt L, Montgomery SM, Granath F, Ekbom A. Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers. BMC Gastroenterol. 2009;9:19.