A patient with CVID may have:
(1) gastritis with or without Helicobacter pylori
(2) small bowel enteropathy that mimics celiac sprue
(3) Candida esophagitis
(4) infectious enteropathy (CMV, Giardia, cryptosporidia, etc)
(5) collagenous enteropathy
(6) lymphocytic colitis
(7) inflammatory bowel disease like changes
Histologic features of CVID enteropathy:
(1) intra-epithelial lymphocytes with villous atrophy
(2) variable lymphoid hyperplasia
(3) variable decrease in plasma cells in the gastrointestinal tract mucosa
The diagnosis of CVID enteropathy requires exclusion of other diagnoses.
A small number of patients may respond to a gluten-free diet, and these patients may have both disorders or an overlap syndrome.
All patients with small bowel enteropathy respond to corticosteroid therapy. Intravenous immume globulin (IVIG) infusion is not associated with improvement in the enteropathy.
