[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Gastrointestinal tract](https://durgical.com/en/general-pathology/areas/gi/) › Other enteropathies

# Other enteropathies

- Lesion

Poor sanitation, faulty immune control, missing enzymes and broken cell machinery can all stop the small bowel absorbing food.

Updated Nov 12, 2026

## Key points

- Environmental enteric dysfunction: chronic exposure to faecal contamination; malabsorption, malnutrition, stunting and poor response to oral vaccines; affects well over a hundred million children; antibiotics and supplements do not reverse it.
- Autoimmune enteropathy: severe diarrhoea in young children; the X-linked IPEX form is caused by FOXP3 loss (no regulatory T cells); antibodies to enterocytes and goblet cells.
- Lactase deficiency: osmotic diarrhoea, bloating and gas after milk; normal histology; acquired loss with age is very common, the congenital autosomal recessive form is rare; temporary loss after enteric infections.
- Microvillus inclusion disease: MYO5B mutations; intractable diarrhoea from the first days of life; apical vesicles containing microvilli seen by electron microscopy or CD10 and villin stains.
- Abetalipoproteinaemia: MTP mutation; no apoB lipoproteins; vacuolated, lipid-laden enterocytes; acanthocytes; fat-soluble vitamin deficiency.

## What it is

Several less common disorders cause malabsorption by different routes. Environmental enteric dysfunction affects children in places with poor sanitation; autoimmune enteropathy reflects failed immune regulation; lactase deficiency is a missing brush-border enzyme; microvillus inclusion disease is a defect of membrane trafficking; abetalipoproteinaemia is a failure to package fat. Each has a distinctive clue, often in the biopsy or blood smear.

## Five rarer causes of malabsorption

| Disorder | Defect | Biopsy clue | Other clue |
| --- | --- | --- | --- |
| [Environmental enteric dysfunction](https://durgical.com/en/conditions/tropical-sprue/) | Barrier and immune damage from repeated faecal exposure | Inflammatory infiltrate, milder villous blunting than coeliac | Stunting in poor-sanitation settings |
| Autoimmune enteropathy | Failed regulatory T cells (FOXP3 in IPEX) | Neutrophils and crypt apoptosis; fewer intraepithelial lymphocytes than coeliac | Endocrinopathy, autoantibodies |
| [Lactase deficiency](https://durgical.com/en/conditions/lactose-intolerance/) | Missing brush-border lactase | Normal | Symptoms after dairy; hydrogen breath test |
| Microvillus inclusion disease | MYO5B: membrane trafficking | Microvillus inclusions (electron microscopy, CD10) | Diarrhoea from birth |
| [Abetalipoproteinaemia](https://durgical.com/en/conditions/abetalipoproteinemia/) | MTP: cannot load lipid onto apoB | Lipid vacuoles in enterocytes (oil red O) | Acanthocytes, absent apoB lipoproteins |

## Clinical notes

- Environmental enteric dysfunction is relevant in rural and poor urban areas of Latin America and contributes to childhood stunting.
- Total parenteral nutrition and small-bowel transplantation are the only options for microvillus inclusion disease.

## Memory aid

Dirt, defence, dairy, delivery trucks and droplets of fat: five ways to fail at absorbing.

## Test yourself

Think of the answer, then tap the question to see it.

## Which gene is mutated in the IPEX form of autoimmune enteropathy?

FOXP3, the transcription factor of regulatory T cells.

## Why is the biopsy normal in lactase deficiency?

The defect is biochemical (a missing brush-border enzyme), not structural.

## What blood-smear finding accompanies abetalipoproteinaemia?

Acanthocytes, red cells with spiky projections from membrane lipid abnormalities.

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## Elsewhere in DurgiPedia

- [Apolipoprotein B (ApoB-100 and ApoB-48)](https://durgical.com/en/biochemistry/enzymes/apolipoprotein-b/)
- [Chylomicron](https://durgical.com/en/biochemistry/topics/chylomicron/)
- [Carbohydrate digestion and absorption](https://durgical.com/en/physiology/carbohydrate-digestion-and-absorption/)

## Connections

## Related 4

- [Malabsorption and diarrhoea](https://durgical.com/en/general-pathology/malabsorption-and-diarrhoea/)
- [Coeliac disease](https://durgical.com/en/general-pathology/coeliac-disease/)
- [Severe acute malnutrition: marasmus and kwashiorkor](https://durgical.com/en/general-pathology/severe-acute-malnutrition-marasmus-and-kwashiorkor/)
- [Vitamin deficiencies: what each one does to tissue](https://durgical.com/en/general-pathology/vitamin-deficiencies-what-each-one-does-to-tissue/)

## Related conditions 4

- [Lactose intolerance](https://durgical.com/en/conditions/lactose-intolerance/)
- [Abetalipoproteinemia (Bassen–Kornzweig syndrome)](https://durgical.com/en/conditions/abetalipoproteinemia/)
- [Tropical sprue](https://durgical.com/en/conditions/tropical-sprue/)
- [Dehydration in children (acute diarrhoeal disease)](https://durgical.com/en/conditions/dehydration-in-children/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Lactose intolerance: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/lactose-intolerance/) (MedlinePlus, US National Library of Medicine, 2025); [Abetalipoproteinemia: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/abetalipoproteinemia/) (MedlinePlus, US National Library of Medicine, 2025); [Microvillus inclusion disease: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/microvillus-inclusion-disease/) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/other-enteropathies/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/other-enteropathies/