From 2-dimensional to 3-dimensional: Overcoming dilemmas in intestinal mucosal interpretation

Table 1 Factors causing mucosal change

Factors causing mucosal change
Mucosal remodelling	Food antigens	Gluten
		Milk
		Soya
		Egg
		Fish
	Drugs	Olmartesan
		Cytotoxic drugs
		Colchicine
		Vinca
		Neomycin
		Ipilimumab
	Autoimmune associated	MVID
		Autoimmune enteropathy
		Collagenous sprue
		IDDM
		Cerebral ataxia
		DH
		Sarcoidosis
	Miscellaneous	Malnutrition
		Crohn’s disease
		Intestinal lymphoma
		Z-E syndrome
		Eosinophilic enteritis
	Antigen-based	Tropical sprue
		GVHD
		Parasitic
		Giardiasis
		Cryptosporidiosis
		Enterocytozoon bieneusi
	Infection	HIV
		TB
		Whipple’s disease
		Bacterial overgrowth
		Immunodeficiencies
		Helicobacter pylori
		Post-infectious diarrhoea
Altered villous heights	Preparative artefacts	Forceps trauma
		Fixation contraction
		Embedding contraction
		Imperfect sectioning
	Social factors	Age
		Ethnicity Gender
		Genetic
		background
		Geo-cultural environment
		Diet
	Microbiome	Intestinal microenvironment
		Maternal
		Infections
	Miscellaneous	Diurnal variation
		Parasites
		Allergy
		Antigenic challenge
		Various drugs
Variations in cell shape	Morphogenic	Cell-cell contact
	Physiologic	Ion-channel fluxes
		Mechano-sensors
		Hydrostatic
	Pathological	Various enteropathies
	Drug-induced	Colchicine, etc
	True mucosal atrophy	Chronic radiation damage
		Chronic ischaemia
		Long-term disuse

MVID: Microvillus inclusion disease; IDDM: Insulin-dependent diabetes mellitus; GVHD: Graft-versus-host disease; HIV: Human immunodeficiency virus; TB: Tuberculosis.