Chronic diarrhea with villous atrophy means a person has loose or watery stools that last for more than four weeks, and a biopsy from the small intestine shows that the “villi” are flat or damaged. Villi are tiny finger-like projections that line the inside of the small intestine and help the body absorb food and nutrients. When they are damaged and become flat (villous atrophy), the intestine cannot absorb food properly, so water, fat, vitamins, and minerals pass out in the stool and cause long-lasting diarrhea and weight loss.
Chronic diarrhea with villous atrophy means a person has loose or watery stools for many weeks or months, and the tiny finger-like projections in the small intestine (villi) are damaged and flattened. When villi are flat, the gut cannot absorb food, vitamins, and fats properly, so stools become loose, pale, and bulky, and the body becomes weak and under-nourished.1 Villous atrophy can happen in celiac disease, some rare genetic diseases, immune problems like common variable immunodeficiency (CVID), infections, and drug-induced enteropathy.23
In some families, doctors describe “chronic diarrhea with villous atrophy” as a rare inherited syndrome that starts in early life and may come with liver, kidney, or brain problems.4 In others, it is mainly due to gluten damage (celiac disease) or immune-related enteropathy. Treatment always has two goals: stop or reduce diarrhea and repair the damaged villi so that the bowel can absorb food again.25
Chronic diarrhea with villous atrophy is not a single disease. It is a pattern that can be caused by many different conditions, such as celiac disease, infections, immune problems, medicines, and even some cancers of the small bowel. Doctors must look carefully at the history, blood tests, stool tests, endoscopy, and biopsy to find the exact cause, because treatment depends on what is damaging the villi.
Other names
Doctors may use several other names or phrases for this problem. These do not always mean exactly the same thing, but they are closely related:
Sprue-like enteropathy – an illness that looks like celiac disease with chronic diarrhea and villous atrophy, but sometimes has different blood tests or causes, such as certain medicines.
Celiac-like enteropathy – villous atrophy that looks like celiac disease under the microscope but may be due to other immune or drug-related causes.
Non-celiac enteropathy with villous atrophy – damage to the small intestine and villi that is not caused by classic celiac disease.
Malabsorptive enteropathy – a general term for small-intestinal disease that leads to poor absorption of nutrients, often with villous atrophy.
Types
Chronic diarrhea with villous atrophy can be grouped by the main underlying cause:
Celiac villous atrophy – classical celiac disease caused by an immune reaction to gluten (a protein in wheat, barley, and rye). It is the most common cause of villous atrophy in many countries.
Seronegative celiac disease – villous atrophy caused by celiac disease even though the usual celiac antibodies in the blood may be negative, so diagnosis relies more on biopsy and response to a gluten-free diet.
Non-celiac immune enteropathies – conditions like autoimmune enteropathy, common variable immunodeficiency (CVID) enteropathy, or graft-versus-host disease, where the immune system attacks the bowel and causes villous damage.
Drug-induced villous atrophy – certain medicines, especially the blood-pressure drug olmesartan and sometimes other drugs, can cause severe chronic diarrhea with villous atrophy that looks like celiac disease.
Infectious enteropathies – chronic infections such as Giardia, HIV-related enteropathy, tropical sprue, or other parasites and bacteria can damage the small intestine and flatten the villi.
Other non-celiac villous atrophy – this group includes inflammatory bowel disease involving the small intestine, small-bowel lymphoma, collagenous sprue, and some rare genetic enteropathies in children.
Causes
Below are 20 important causes of chronic diarrhea with villous atrophy. Many patients may have more than one factor at the same time.
1. Classic celiac disease (gluten-sensitive enteropathy)
Celiac disease is an autoimmune disease where eating gluten triggers the immune system to attack the small intestine. This attack destroys the villi, causing villous atrophy, malabsorption, and chronic diarrhea, often with weight loss and anemia. A strict lifelong gluten-free diet usually leads to healing of the villi and improvement of symptoms.
2. Seronegative celiac disease
Some people have villous atrophy typical for celiac disease but their celiac antibody blood tests are negative. They may still have the genetic risk (HLA-DQ2 or HLA-DQ8) and respond to a gluten-free diet. This is called seronegative celiac disease and must be carefully separated from other non-celiac villous atrophy causes.
3. Refractory celiac disease
In refractory celiac disease, the villi remain flat and diarrhea continues even after strict gluten-free eating for a long time. Cells in the intestine may become abnormal, and there is a higher risk of a special type of lymphoma. This is a serious condition that needs expert care and often strong immune-suppressing treatment.
4. Autoimmune enteropathy
Autoimmune enteropathy is a rare disease where the immune system produces antibodies that attack the lining of the intestine, causing severe chronic diarrhea and villous atrophy. It can happen in both children and adults and often needs strong medicines such as steroids or other immunosuppressive drugs to control the inflammation.
5. Common variable immunodeficiency (CVID) enteropathy
CVID is a disorder in which the body does not make enough normal antibodies, leading to repeated infections and sometimes chronic diarrhea. In some patients, the small intestine shows villous atrophy and inflammation similar to celiac disease but without gluten as the cause. Treatment focuses on immunoglobulin replacement and managing infections and inflammation.
6. Olmesartan-induced enteropathy
Olmesartan, a blood-pressure medicine, can in some people cause severe chronic watery diarrhea, major weight loss, and villous atrophy that looks like celiac disease but with negative celiac antibodies. Symptoms usually improve after the drug is stopped, which is why a careful drug history is very important in patients with villous atrophy.
7. Enteropathy from other drugs (e.g., other ARBs, NSAIDs, mycophenolate, chemotherapy)
Other medicines, including some angiotensin receptor blockers, non-steroidal anti-inflammatory drugs (NSAIDs), mycophenolate mofetil, and some cancer chemotherapy drugs, can injure the small intestine. They may cause inflammation, ulcers, and villous atrophy, leading to chronic diarrhea and weight loss. Stopping or changing the drug is often the key step in treatment.
8. Tropical sprue
Tropical sprue is a chronic malabsorption disease seen mostly in people who live in or travel to certain tropical regions. Patients have chronic diarrhea, weight loss, and villous atrophy, often with deficiency of folate and vitamin B12. The cause is not fully clear but is probably related to chronic infection and environmental factors, and it is often treated with antibiotics and vitamin supplements.
9. Giardiasis
Giardia is a parasite that can infect the small intestine. Long-lasting infection can cause irritation and atrophy of the villi, leading to chronic diarrhea, gas, bloating, and weight loss. Diagnosis is made by stool tests or antigen tests, and treatment is with specific antiparasitic drugs.
10. Other chronic intestinal infections (e.g., Cryptosporidium, CMV, HIV enteropathy)
In people with weak immune systems, such as those with advanced HIV or on strong immunosuppressive drugs, chronic infections with organisms like Cryptosporidium, cytomegalovirus (CMV), or other pathogens can damage the small intestine and cause villous atrophy with diarrhea. These infections need targeted antiviral or antiparasitic treatment alongside immune support.
11. Small intestinal bacterial overgrowth (SIBO)
In SIBO, too many bacteria live in the small intestine. These bacteria interfere with digestion and may directly damage the mucosa, sometimes leading to partial villous atrophy and malabsorption. Patients often have bloating, gas, and diarrhea, and diagnosis may use breath tests or aspirate cultures, with treatment based on antibiotics and treating underlying causes.
12. Crohn’s disease involving the small intestine
Crohn’s disease is a chronic inflammatory bowel disease that can involve any part of the digestive tract, including the small bowel. Inflammation, ulcers, and scarring can distort the villi and cause a pattern that may overlap with villous atrophy, together with chronic diarrhea, abdominal pain, and weight loss.
13. Eosinophilic gastroenteritis / enteritis
In eosinophilic enteritis, large numbers of eosinophils (a type of white blood cell) build up in the wall of the intestine. This can cause structural damage, villous blunting, and protein loss, leading to diarrhea, abdominal pain, and sometimes swelling of the legs due to low albumin.
14. Collagenous sprue
Collagenous sprue is a rare disease in which a thick layer of collagen builds up under the surface of the small intestinal mucosa, together with villous atrophy. Patients have severe malabsorption and diarrhea, and the disease may be linked to celiac disease or other immune conditions.
15. Enteropathy-associated T-cell lymphoma and other small-bowel lymphomas
Certain cancers of the immune cells in the small intestine, especially enteropathy-associated T-cell lymphoma, may grow in a background of villous atrophy. Patients can have chronic diarrhea, weight loss, abdominal pain, and sometimes bleeding or obstruction. This makes careful biopsy review very important.
16. Radiation enteritis
Radiation therapy to the abdomen or pelvis can injure the small intestine. Months or years later it can cause chronic diarrhea, narrowing, and sometimes villous atrophy because of scarring and poor blood supply. Symptoms can be long-lasting and hard to manage.
17. Graft-versus-host disease (GVHD) of the gut
After bone marrow or stem cell transplant, donor immune cells can attack the patient’s intestines, producing graft-versus-host disease. The small bowel can show villous atrophy and inflammation, leading to severe watery diarrhea, pain, and weight loss. Treatment usually involves immunosuppressive medicines.
18. Congenital or monogenic enteropathies (e.g., microvillus inclusion disease, tufting enteropathy)
Some babies are born with genetic disorders of the intestinal lining. Their villi may be abnormal from birth, and they develop chronic diarrhea and failure to thrive very early in life. Biopsies show characteristic changes such as microvillus inclusions or epithelial “tufting,” often together with villous atrophy.
19. Whipple disease
Whipple disease is a rare infection caused by Tropheryma whipplei that affects the small intestine and other organs. It can cause villous damage, chronic diarrhea, weight loss, joint pain, and sometimes brain or heart problems. Biopsy shows special “foamy” macrophages, and long-term antibiotics are needed.
20. Idiopathic villous atrophy
In some patients, villous atrophy and chronic diarrhea remain even after careful evaluation and exclusion of known causes. This group is often called idiopathic villous atrophy, and ongoing research is trying to better understand these cases and their best treatment options.
Symptoms
1. Chronic watery or loose stools
The main symptom is diarrhea that lasts for more than four weeks. Stools are often watery or very loose, and they may occur many times a day, sometimes even at night, because the damaged villi cannot absorb water and nutrients properly.
2. Greasy, bulky, or foul-smelling stools (steatorrhea)
If fat is not absorbed, the stools may look pale, bulky, and oily, and may float or stick to the toilet bowl. This is called steatorrhea and is a sign of fat malabsorption due to villous atrophy.
3. Urgency and possible fecal incontinence
Because the bowel is irritated and full of fluid, many patients feel a strong need to rush to the toilet and may have trouble holding stool, which can be very distressing and affect daily life and social activities.
4. Abdominal pain or cramping
Crampy belly pain is common. It may come from fast intestinal movement, gas, or inflammation in the small bowel, and often gets worse after meals, when the intestine is working harder.
5. Bloating and excess gas
Unabsorbed carbohydrates and fats in the bowel are fermented by bacteria and produce gas. This leads to a feeling of fullness, bloating, and passing more gas than usual.
6. Weight loss and muscle wasting
Because nutrients are not absorbed properly, many patients lose weight without trying. Over time, muscles can become thin and weak, and clothes may feel loose even though the person is eating normal amounts of food.
7. Fatigue and low energy
Lack of calories, protein, vitamins, and minerals makes people feel tired, weak, and less able to do daily tasks or exercise. This tiredness often does not improve with rest alone.
8. Symptoms of anemia (pallor, shortness of breath, dizziness)
Poor absorption of iron, folate, or vitamin B12 can cause anemia. Patients may look pale, feel short of breath with mild activity, or feel dizzy when standing up because their blood cannot carry enough oxygen.
9. Easy bruising or bleeding
Vitamin K and other clotting factors may be low because of malabsorption. People may bruise easily, have nosebleeds, or bleed more than usual after minor injuries or dental work.
10. Bone pain or fractures
If vitamin D and calcium are not absorbed, bones can become thin and weak (osteopenia or osteoporosis). Patients might have bone pain, back pain, or fractures after minor falls or even normal daily activity.
11. Swelling of legs or ankles (edema)
Low blood protein, especially low albumin, due to protein loss in the gut can cause fluid to leak into tissues. This leads to puffy ankles, feet, or even swelling around the eyes.
12. Mouth ulcers and glossitis (sore tongue)
Low levels of iron, folate, or B vitamins can cause painful mouth ulcers and a smooth, red, or burning tongue. These are visible signs that often point to chronic nutritional problems.
13. Skin rashes (for example, dermatitis herpetiformis in celiac disease)
Some people with celiac disease and villous atrophy develop a very itchy, blistering skin rash called dermatitis herpetiformis, usually on elbows, knees, and buttocks. Other nutrient-related skin changes, such as dry skin or hair loss, can also occur.
14. Numbness or tingling in hands and feet (peripheral neuropathy)
Long-term lack of vitamin B12 and other nutrients can damage nerves. Patients may feel pins and needles, burning, or numbness in their hands and feet, and sometimes have trouble with balance.
15. Poor growth or delayed puberty in children
In children, chronic diarrhea with villous atrophy can lead to failure to gain weight or height as expected, delayed puberty, and learning or attention problems due to chronic under-nutrition.
Diagnostic tests
Physical exam
1. General physical examination and vital signs
The doctor checks weight, height, blood pressure, heart rate, and overall appearance. They look for signs of dehydration, fever, pallor, or weakness. These findings help judge how severe the illness is and whether the person needs urgent treatment or hospital care.
2. Detailed abdominal examination
The abdomen is inspected, listened to, and gently pressed to find tenderness, bloating, masses, or abnormal bowel sounds. This exam helps distinguish functional causes from serious inflammation, obstruction, or enlarged organs.
3. Nutritional status examination
Doctors look at body mass index, muscle bulk, skin, hair, and nails to look for signs of malnutrition, such as muscle wasting, hair thinning, or dry skin. They may also check for ankle swelling, which can signal low albumin from protein loss.
4. Neurological and musculoskeletal examination
A simple bedside check of reflexes, strength, sensation, and balance can reveal neuropathy and muscle weakness due to vitamin and mineral deficiencies, which supports a diagnosis of chronic malabsorption.
Manual (bedside) tests
5. Stool diary and Bristol stool chart
Keeping a daily record of how often the patient passes stool, what it looks like, and whether there is pain or urgency helps classify the type of chronic diarrhea and guides further testing. The Bristol stool chart is a simple picture guide for describing stool consistency.
6. Bedside assessment of hydration and orthostatic blood pressure
The doctor checks skin turgor, dryness of mouth, and capillary refill and measures blood pressure lying and standing. A big drop in blood pressure or increase in heart rate when standing suggests volume loss from diarrhea and helps decide about fluid replacement.
Lab and pathological tests
7. Complete blood count (CBC) and iron studies
CBC can show anemia, high or low white blood cells, or low platelets. Iron studies help identify iron-deficiency anemia, which is common in malabsorption and celiac disease. These tests are an important early clue to villous atrophy–related disease.
8. Serum electrolytes, kidney and liver function, and albumin
Blood tests for sodium, potassium, bicarbonate, urea, creatinine, liver enzymes, and albumin show the effects of chronic diarrhea and malabsorption on the body. Low albumin and abnormal electrolytes suggest severe disease and help guide fluid and nutrition therapy.
9. Vitamin and mineral levels (B12, folate, vitamin D, calcium, magnesium)
Measuring these nutrients helps confirm malabsorption. Low B12, folate, or vitamin D are very common in villous atrophy, and identifying deficiencies guides proper replacement therapy to prevent nerve and bone complications.
10. Celiac serology panel and total IgA
Blood tests such as tissue transglutaminase IgA (tTG-IgA), endomysial antibody (EMA), or deamidated gliadin peptides (DGP) are used to screen for celiac disease. Measuring total IgA is important because low IgA can make these tests falsely negative, so IgG-based tests may be needed.
11. Immunoglobulin levels and HIV testing
Total immunoglobulin levels (IgG, IgA, IgM) help detect conditions like CVID, while HIV testing looks for HIV-related enteropathy and opportunistic infections. Both problems can lead to villous atrophy and chronic diarrhea and need specific management.
12. Stool culture and Clostridioides difficile toxin testing
Stool culture looks for bacterial infections such as Salmonella or Campylobacter, and specific tests look for C. difficile toxins in people with antibiotic use or hospital stays. While these infections usually cause more acute diarrhea, they may complicate chronic conditions and must be ruled out.
13. Stool ova and parasites and Giardia antigen tests
Microscopic examination and antigen tests on stool can detect parasites such as Giardia and Cryptosporidium that cause chronic diarrhea and sometimes villous damage, especially in travelers or immunocompromised patients.
14. Fecal fat test or fecal elastase
A qualitative or quantitative fecal fat test shows whether fat is being lost in the stool, which suggests malabsorption. Fecal elastase helps decide if pancreatic insufficiency is contributing; both tests help separate small bowel villous atrophy from pancreatic causes.
15. D-xylose absorption test
The patient drinks a sugar called D-xylose, and its level is measured in blood or urine. Poor absorption suggests small bowel mucosal disease such as villous atrophy, whereas normal absorption points more toward pancreatic or other causes of malabsorption.
16. Upper endoscopy with small bowel biopsies and histology
Endoscopy allows the doctor to look directly at the upper small intestine and take multiple biopsies from the duodenum and sometimes jejunum. The pathologist examines the tissue to confirm villous atrophy, increased inflammatory cells, or specific patterns that point to celiac disease, drug-induced enteropathy, infections, lymphoma, or other causes. This is the key test for diagnosis.
Electrodiagnostic tests
17. Nerve conduction studies and electromyography (EMG)
In patients with numbness, tingling, or weakness, nerve conduction studies and EMG can show damage to peripheral nerves due to long-standing vitamin deficiencies from malabsorption. These findings support the idea that villous atrophy has led to systemic nutritional problems that must be corrected.
18. Autonomic function tests
Tests that measure heart-rate and blood-pressure responses to standing or deep breathing can show damage to the autonomic nervous system. This can occur in advanced nutritional deficiency and may explain dizziness, faintness, or abnormal gut motility in some patients.
Imaging tests
19. Abdominal ultrasound
Ultrasound is a simple imaging test that can look for enlarged lymph nodes, fluid in the abdomen, or liver and gallbladder disease that might accompany chronic enteropathy. Although it does not show villi directly, it helps rule out other causes of chronic diarrhea and weight loss.
20. CT or MR enterography and capsule endoscopy
CT or MR enterography provides detailed pictures of the small intestine, showing thickening, strictures, or masses that suggest Crohn’s disease, lymphoma, or other structural problems. Capsule endoscopy (swallowing a small camera) lets doctors see the entire small bowel lining and can reveal widespread villous atrophy or ulcers that are not reached by standard endoscopy.
Non-pharmacological treatments
1. Strict gluten-free diet (when celiac disease is present)
If tests show celiac disease, a strict gluten-free diet is the main treatment. This means avoiding all foods with wheat, barley, and rye. Over time, this diet lets villi grow back, so the bowel can absorb nutrients and diarrhea improves. Even “small” gluten exposures (bread crumbs, soy sauce) can restart damage, so label-reading and dietitian help are very important.6
2. Targeted elimination diet for food triggers
Some people have non-celiac gluten sensitivity, lactose intolerance, or reactions to certain food chemicals. A doctor or dietitian may use an elimination diet: you remove suspected foods for a few weeks, then add them back one by one while watching stool pattern, gas, and pain. This simple step helps to find hidden triggers and reduce diarrhea without unnecessary long-term food bans.7
3. Lactose-free or low-lactose diet
Damaged villi often lose lactase, the enzyme that breaks down milk sugar. Milk, ice-cream, and soft cheeses can then cause bloating and watery stools. A trial of lactose-free milk, yogurt with live cultures, or hard cheese (naturally lower in lactose) may reduce symptoms. If dairy is limited, calcium and vitamin D from other foods or supplements are important to protect bones.8
4. Low-FODMAP or reduced fermentable carbohydrate diet
FODMAPs are certain sugars and fibers that pull water into the bowel and are fermented by gut bacteria. In sensitive people, they cause gas, cramps, and loose stool. Under supervision, a low-FODMAP trial (lowering onions, garlic, some fruits, wheat, and certain sweeteners) can calm the bowel. Later, foods are slowly re-introduced to find a personal safe level.9
5. Oral rehydration solution (ORS)
Long-lasting diarrhea can quietly drain water and salts from the body. ORS is a simple drink with the right balance of salts and glucose so the intestine can pull fluid back into the blood. Sipping ORS in small frequent amounts helps prevent dizziness, kidney strain, and hospital visits. Home-made ORS or commercial packets are cheap tools that can save lives.10
6. High-energy, high-protein, easily digested meals
Because villi are damaged, people with this condition often lose weight and muscle. Small, frequent meals with soft, low-fat, high-protein foods (eggs, fish, well-cooked lentils, yogurt) are easier to digest. Using energy-dense additions like nut butters, vegetable oils, or prescribed nutrition drinks can help the body catch up on lost calories and support gut healing.11
7. Enteral nutrition through feeding tube (when oral intake is poor)
If a person cannot eat enough by mouth because of severe diarrhea, nausea, or weakness, liquid feeds can be given by a tube into the stomach or small intestine. Formulas are carefully balanced for calories, protein, and micronutrients. This method rests the person from the stress of eating large meals while still feeding the gut, which helps maintain villi structure and function.12
8. Parenteral nutrition (IV nutrition) in severe malabsorption
In very severe villous atrophy, the gut may not absorb enough even with tube feeds. In these rare cases, nutrition is given directly into a vein through a central line. The solution contains glucose, amino acids, fats, vitamins, and minerals. This is a complex, hospital-led therapy used to prevent starvation and give time for the intestine to recover or for other treatments to work.13
9. Probiotics (with careful medical guidance)
Some studies suggest certain probiotic strains (like Lactobacillus and Bifidobacterium) may improve stool form and reduce inflammation in chronic diarrhea and IBS-D. They act by competing with harmful bacteria and making beneficial short-chain fatty acids. However, evidence is mixed, doses vary, and in people with immune problems there is a small risk of infection, so medical advice is important before use.14
10. Soluble fiber and prebiotics
Soluble fiber (psyllium husk, oats, some fruits) absorbs water and forms a soft gel in the bowel. This can make stool less watery and more formed. Prebiotic fibers also feed helpful bacteria. However, too much at once may increase gas and cramps. Doctors often suggest starting with low doses and slowly increasing as tolerated, always with good fluid intake.15
11. Stress management and psychological support
Stress can speed up gut movement and make diarrhea worse. People with long-lasting illness also often feel anxious or depressed. Relaxation techniques (deep breathing, mindfulness), cognitive-behavioural therapy, or supportive counseling can reduce gut-brain stress signals. This does not “cure” villous atrophy, but it can reduce symptom flares and improve quality of life.16
12. Pelvic floor and bowel habit training
Chronic diarrhea can weaken the pelvic floor muscles, leading to urgency and leakage. A physiotherapist can teach exercises to strengthen these muscles and create a bathroom routine that reduces accidents. Practicing going at regular times, not “just in case,” and using correct toilet posture can help the bowel empty more calmly and predictably.17
13. Careful medication review and adjustment
Some medicines, such as certain blood pressure drugs (like olmesartan), chemotherapy, antibiotics, or magnesium-containing antacids, can cause or worsen villous damage and diarrhea. Doctors review all tablets, herbal medicines, and over-the-counter products and may stop or switch those that harm the gut. This simple step can greatly improve symptoms without extra drugs.18
14. Infection prevention and hygiene
People with immune problems or malnutrition get infections more easily. Good hand washing, safe drinking water, careful food handling, and safe cooking temperatures help avoid added infections like Giardia or C. difficile, which worsen diarrhea. Appropriate vaccines (according to age and immune status) also reduce serious infections and hospital stays.19
15. Sunlight and gentle physical activity
Short daily walks and safe sunlight exposure support bone and muscle health, mood, and vitamin D status. Activity also helps bowel movement become more regular. In weak patients, activity plans must be slow and supervised, but even small steps and stretching can support recovery when combined with good nutrition and medical care.20
16. Skin care and protection around the anus
Frequent loose stools can burn and irritate the skin. Washing gently with water, patting dry (not rubbing), using barrier creams with zinc oxide, and changing pads or diapers promptly protects the skin. This lowers pain, itching, and risk of skin infection, which makes living with chronic diarrhea less stressful.21
17. Education about disease and self-management
Understanding why diarrhea happens and how treatments work makes people more confident and more likely to follow the plan. Doctors and nurses can explain test results, long-term plan, diet choices, and “red flag” symptoms. Written leaflets or trusted websites help families review information at home and avoid harmful myths.22
18. Support groups and patient communities
Living with chronic diarrhea and dietary limits can feel lonely. Support groups, in person or online, allow people to share tips about diet, coping at school or work, and dealing with embarrassment. Hearing others’ experiences often reduces fear and helps people ask better questions at clinic visits.23
19. Regular follow-up with gastroenterology and immunology
Because villous atrophy has many causes, people often need ongoing care with specialists. Regular visits allow doctors to check growth, weight, vitamin levels, bone density, and infection rate. They can adjust diet, medicines, and vaccinations in time, and watch for rare complications like intestinal failure or liver disease.24
20. Family genetic and immune counseling (for inherited or immune causes)
When villous atrophy is part of a primary immunodeficiency or rare genetic syndrome, specialists may offer genetic testing and counseling. This helps families understand inheritance, future pregnancy risks, and early warning signs in relatives. It also guides decisions about advanced treatments like immunoglobulin therapy or stem cell transplant.25
Drug treatments
Important: The doses below are typical adult doses taken from evidence-based sources, including FDA labels, but they are not personal medical advice. Children, older adults, people with kidney or liver disease, pregnant people, and those on other medicines need different doses. Never start, stop, or change these medicines without a doctor.
1. Loperamide
Loperamide is an opioid-like antidiarrheal that slows bowel movement and improves stool consistency. It belongs to the “peripheral opioid receptor agonist” class. A common adult dose is 4 mg at the start, then 2 mg after each loose stool, up to 16 mg per day, but long-term dosing should be guided by a specialist.26 It works by reducing gut motility and secretions. Side effects include constipation, abdominal cramps, and, in high doses, dangerous heart rhythm problems.27
2. Diphenoxylate-atropine (Lomotil)
Diphenoxylate-atropine combines an opioid (diphenoxylate) with a low dose of atropine to slow gut movement and discourage misuse. It is usually used short-term when loperamide is not enough. A typical adult starting dose is 2 tablets four times daily, then reduced as diarrhea improves.28 It slows intestinal motility, giving more time for fluid absorption. Side effects include drowsiness, dry mouth, constipation, and, in overdose, serious breathing depression—especially dangerous in children.29
3. Cholestyramine
Cholestyramine is a bile acid sequestrant. It is helpful when diarrhea is caused by bile acids reaching the colon, such as after ileal disease or resection. It is usually taken as a 4 g powder packet once or twice daily with meals, adjusted to effect.30 It binds bile acids in the gut so they cannot irritate the colon. Side effects are bloating, constipation, and interference with absorption of other medicines and fat-soluble vitamins if timing is not careful.31
4. Rifaximin (Xifaxan)
Rifaximin is a non-absorbed antibiotic that stays mainly in the gut. It is used for conditions like IBS-D and sometimes small intestinal bacterial overgrowth, which can worsen chronic diarrhea.32 A usual adult regimen for IBS-D is 550 mg three times daily for 14 days, but protocols vary.33 It works by reducing certain gut bacteria and lowering inflammation. Side effects include nausea, flatulence, and rare C. difficile infection.
5. Budesonide (oral)
Budesonide is a steroid that acts mainly inside the bowel with fewer whole-body effects than prednisone. Modified-release forms are used for Crohn’s disease and microscopic colitis, and sometimes for immune-mediated enteropathy.34 A common adult dose is 9 mg once daily for several weeks, then slowly reduced.35 It decreases local inflammation and allows villi to heal. Side effects include mood changes, weight gain, high blood sugar, and, long term, bone thinning—so doctors try to limit duration.36
6. Prednisone (systemic corticosteroid)
Prednisone is a strong oral steroid used when villous atrophy is driven by autoimmune enteropathy, CVID-related gut inflammation, or severe celiac-like disease not responding to diet. Doses vary; a common induction dose might be 0.5–1 mg/kg/day, then slowly tapered.37 Prednisone suppresses immune attack on the villi but affects the whole body. Side effects include weight gain, high blood pressure, infection risk, mood swings, and bone loss, so it is kept as short as possible.38
7. Azathioprine (Imuran)
Azathioprine is an immunosuppressant often used as a “steroid-sparing” drug in chronic immune-mediated enteropathy or inflammatory bowel disease. Typical adult doses are around 1.5–2.5 mg/kg/day, adjusted by blood tests.39 It reduces overactive T and B-cell responses that attack the intestine. Side effects include low blood counts, liver irritation, infection risk, and a small increase in certain cancers, so regular lab monitoring is essential.40
8. Methotrexate (low-dose weekly)
Methotrexate, at low weekly doses, is sometimes used for autoimmune gut disease when other treatments fail. A common adult dose is 10–25 mg once weekly, together with folic acid, but dosing is highly individualized.41 It slows immune cell division and calms inflammation in the intestinal lining. Side effects can include nausea, mouth sores, liver toxicity, and bone marrow suppression. Alcohol is usually restricted, and pregnancy must be avoided.42
9. Anti-TNF biologics (e.g., infliximab)
Infliximab and related anti-TNF drugs are biologic antibodies used for Crohn’s disease, ulcerative colitis, and some severe immune enteropathies. They are given by IV infusion at induction weeks, then every 4–8 weeks, with doses like 5 mg/kg, adjusted as needed.43 They block TNF-α, a key inflammatory signal, to reduce mucosal damage. Serious side effects include increased risk of serious infections (TB, fungal), infusion reactions, and rare neurologic or blood disorders.44
10. Vedolizumab
Vedolizumab is a gut-selective biologic that blocks α4β7 integrin, limiting immune cell entry into the bowel wall. It is approved for ulcerative colitis and Crohn’s disease, and some case series show benefit in CVID-related enteropathy with diarrhea and weight loss.45 It is given as an IV infusion at 0, 2, and 6 weeks, then every 8 weeks. It mainly causes headache, nasopharyngitis, and infusion reactions; systemic infections are less common than with anti-TNF drugs but still possible.46
11. Intravenous immunoglobulin (IVIG)
For patients whose villous atrophy is part of common variable immunodeficiency or other antibody deficiencies, IVIG is a cornerstone treatment. It is given by drip every 3–4 weeks, with doses often around 400–600 mg/kg, personalized for infection control.47 IVIG supplies pooled antibodies from healthy donors, improving defense against infections that can worsen diarrhea and malnutrition. Side effects include headache, chills, fatigue, and, rarely, kidney problems, thrombosis, or aseptic meningitis.48
12. Subcutaneous immunoglobulin (SCIG)
SCIG is another way to give immunoglobulin, injected under the skin weekly or bi-weekly. Doses are similar per month to IVIG but split into smaller, more frequent doses.49 It keeps antibody levels steady, helping reduce infections that trigger or worsen diarrhea. It can be done at home after training. The main side effects are local swelling, redness, and mild flu-like symptoms, usually less intense than IVIG reactions.50
13. Pancrelipase (CREON and similar)
Some patients with villous atrophy also have exocrine pancreatic insufficiency, causing greasy diarrhea and weight loss. Pancrelipase capsules contain digestive enzymes (lipase, protease, amylase) from pig pancreas. Typical adult starting doses are 500–1,000 lipase units/kg per meal, adjusted by symptom and fat intake.51 The enzymes help break down fat and protein so they can be absorbed, reducing steatorrhea. Side effects include abdominal pain, constipation, and, at very high doses, risk of colonic strictures in children.52
14. Proton pump inhibitors (PPIs, e.g., omeprazole)
PPIs decrease stomach acid. In some patients they help protect the upper small intestine and are used to manage associated reflux or ulcer disease. Usual adult doses are around 20–40 mg once daily before breakfast. They work by blocking the acid-producing proton pump in stomach cells. Long-term use can slightly increase risks of infections like C. difficile and reduce magnesium or vitamin B12 levels, so the lowest effective dose is preferred.53
15. Ondansetron and other antiemetics
When chronic diarrhea is accompanied by vomiting, antiemetics like ondansetron can help patients keep fluids and medicines down. A typical adult oral dose is 4–8 mg up to three times daily as needed. Ondansetron blocks serotonin 5-HT3 receptors in the gut and brain that trigger nausea and vomiting. Side effects include headache, constipation, and, at high doses, rare heart rhythm changes.54
16. Antibiotics for specific infections (e.g., metronidazole for Giardia)
If stool tests show infections such as Giardia, C. difficile, or bacterial overgrowth, targeted antibiotics are needed. The exact drug, dose, and duration depend on the organism and local guidelines. Clearing these infections can reduce inflammation and allow villi to recover. However, unnecessary antibiotics may worsen diarrhea by disturbing normal gut flora, so treatment should always be test-guided.55
17. Bile acid testing-guided bile acid sequestrants
In some chronic diarrhea patients, tests show bile acid malabsorption. Bile acid sequestrants like colesevelam or colestipol are alternatives to cholestyramine. They are taken in tablet form with meals. Like cholestyramine, they bind bile acids and reduce their irritating effect on the colon. Side effects include constipation and bloating, and they may affect absorption of other medicines, so timing and monitoring matter.56
18. 5-HT3 antagonists (e.g., alosetron in selected IBS-D cases)
In some people with chronic watery diarrhea overlapping with IBS-D, 5-HT3 antagonists can reduce urgency and stool frequency. They work by blocking serotonin receptors on gut nerves, slowing transit and reducing pain.57 Use is usually restricted to severe, refractory cases because of risks like constipation and rare ischemic colitis. These drugs are specialist-only and not first-line for villous atrophy itself.
19. Zinc supplementation (therapeutic doses)
Zinc is sometimes prescribed at therapeutic doses (e.g., 20 mg elemental zinc 1–2 times daily for a limited period) in chronic diarrhea, especially in children, to support gut barrier repair and immune function. It stabilizes cell membranes and tight junctions in the intestinal lining. Excess or long-term high doses can interfere with copper absorption and cause nausea, so dosing must be controlled.58
20. Vitamin D and calcium (prescription strength)
Because villous atrophy reduces absorption of vitamin D and calcium, doctors often prescribe higher-dose vitamin D (for example, 1,000–2,000 IU daily, or short-course higher doses) plus calcium as needed, based on blood levels and bone scans. Vitamin D helps regulate immune responses and maintain bone health. Too much can cause high calcium and kidney stones, so tests are repeated and doses adjusted.59
Dietary molecular supplements
1. Oral rehydration salts (ORS) powder
ORS powders contain precise amounts of sodium, potassium, glucose, and citrate. When mixed correctly with clean water, they use special sugar–salt transporters in the small intestine to pull water back into the body even when villi are partly damaged. Regular use during diarrhea episodes helps prevent dehydration, kidney injury, and fainting without giving too much sugar, which can worsen diarrhea.60
2. Zinc gluconate or zinc sulfate
Zinc supplements support the repair of the intestinal barrier and help immune cells fight infections. In chronic diarrhea, they may shorten episodes and reduce severity, especially in children. A typical course uses 10–20 mg elemental zinc daily for several weeks, adjusted by age and labs. It works by stabilizing membranes and enzymes. Too much zinc can upset the stomach and lower copper levels, so dosing is monitored.61
3. Vitamin D3 (cholecalciferol)
Low vitamin D is common in malabsorption. Vitamin D3 regulates calcium absorption and also shapes immune responses in the gut. Supplementation (for example 800–2,000 IU daily, or higher short-term under supervision) helps bones, muscles, and immune balance. Mechanistically, it binds nuclear receptors in many cells and changes gene expression. Blood tests guide dose to avoid toxicity such as high calcium or kidney stones.62
4. Vitamin B12 (oral or injection)
Villous atrophy, especially in the terminal ileum, causes vitamin B12 malabsorption. B12 is crucial for red blood cell production and nerve health. Doctors may give high-dose oral B12 or injections (e.g., 1,000 µg monthly) depending on levels. B12 acts as a cofactor in DNA synthesis and myelin maintenance. Correcting deficiency improves anemia, fatigue, and sometimes diarrhea related to poor mucosal renewal.63
5. Folate (folic acid)
Folate deficiency can develop with small bowel disease, especially if diet is low. Folate is needed for DNA synthesis in rapidly dividing villus cells. Supplements (e.g., 400–1,000 µg daily) help the intestine regenerate and correct megaloblastic anemia. It acts in one-carbon metabolism pathways. High doses can mask B12 deficiency, so doctors often check both vitamins and treat together if needed.64
6. Iron (oral or IV)
Chronic blood loss and malabsorption often lead to iron deficiency anemia. Iron tablets (e.g., 40–65 mg elemental iron once daily) or IV iron can restore iron stores. Iron is essential for hemoglobin and many enzymes. Better oxygen delivery improves fatigue and allows more physical activity, supporting gut health indirectly. Iron can cause nausea, dark stools, and constipation, so gentle dosing and forms (or IV) may be needed.65
7. Medium-chain triglyceride (MCT) oil
MCTs are fats that are absorbed more easily because they do not need bile and are taken directly into the portal vein. Adding small amounts (e.g., 1–3 teaspoons spread through the day) to food or drinks can raise calorie intake without worsening steatorrhea. They provide quick energy and may help under-weight patients gain weight while villi recover.66
8. Glutamine powder
Glutamine is an amino acid used as fuel by enterocytes (intestinal lining cells). Supplements (for example, 5 g powder mixed into drinks one to three times daily) are sometimes used in malabsorption states. It may support mucosal repair and tight-junction function. Evidence in chronic diarrhea is mixed, so it is usually considered an adjunct, not a main therapy. High doses may cause GI discomfort in some people.67
9. Omega-3 fatty acids (fish oil)
Omega-3 fatty acids (EPA/DHA) have anti-inflammatory effects. Typical supplemental doses are 1–3 g combined EPA/DHA per day. They act by changing the types of eicosanoids and resolvins produced, which can calm chronic inflammation. In villous atrophy, they might modestly support mucosal healing and cardiovascular health, but they can thin the blood slightly and cause fishy after-taste or reflux.68
10. Serum-derived bovine immunoglobulin (SBI, EnteraGam – medical food)
SBI is a special protein isolate derived from cow serum, sold as a medical food for chronic diarrhea. It is taken as a powder mixed with liquid and used under doctor supervision. SBI binds bacterial toxins and antigens in the gut lumen and may improve stool consistency and GI symptoms in chronic loose-stool conditions.69 It is not absorbed as a drug but acts locally. People with beef allergy must avoid it.
Immunity-boosting, regenerative, and stem-cell-related therapies
1. Intravenous immunoglobulin (IVIG) as immune replacement
In antibody deficiencies like CVID that present with chronic diarrhea and villous atrophy, regular IVIG infusions are one of the most important “immune-boosting” treatments. They restore normal IgG levels, reduce infections, and may indirectly reduce gut inflammation.70 IVIG does not replace specific gut drugs but supports the whole immune system, giving the intestine a better chance to heal.
2. Subcutaneous immunoglobulin (SCIG)
SCIG serves the same replacement role as IVIG but with smaller, more frequent under-skin doses. It maintains a stable antibody level and can be self-administered at home after training. This steady support reduces infections that worsen diarrhea and helps some patients stay out of hospital.71
3. Hematopoietic stem cell transplantation (HSCT) for primary immunodeficiencies
In some combined immunodeficiencies or severe immune disorders with chronic diarrhea, HSCT from a donor can rebuild the entire immune system. Stem cells are collected from bone marrow or peripheral blood, then infused after chemotherapy conditioning.72 Over time, the new immune system can stop the attacks on the intestine and control infections, allowing villi to regrow. HSCT has serious risks (graft-versus-host disease, infections) and is reserved for selected severe cases.
4. Experimental mesenchymal stem cell therapies
Mesenchymal stem cells (MSCs) from bone marrow, fat, or cord blood are being studied in inflammatory bowel disease and some immune diseases. They are thought to home to inflamed tissues and release anti-inflammatory factors that help repair mucosa. At present, MSC therapy for villous atrophy-related diarrhea remains experimental and is usually available only in clinical trials. Patients should avoid unregulated “stem cell clinics.”
5. Biologic drugs that promote mucosal healing (e.g., anti-TNF, vedolizumab)
Although already listed under drug treatments, biologics like infliximab and vedolizumab can be viewed as “regenerative helpers” because they allow the mucosa to heal by shutting down deep inflammation.73 When inflammation is controlled, villi can regrow, absorption improves, and diarrhea often settles. These drugs are powerful and must be prescribed and monitored by experienced specialists.
6. Intensive nutrition-supported bowel rehabilitation
Comprehensive bowel rehabilitation programs combine high-calorie tailored feeds, micronutrient replacement, and sometimes growth factors under close supervision. The goal is to allow maximum villus regrowth and, in some patients, to avoid or come off long-term parenteral nutrition. Although not a “single drug,” this package is regenerative for the intestine, giving cells the building blocks they need to repair damage.
Surgeries and procedures
1. Central venous catheter placement for long-term parenteral nutrition
In severe malabsorption where oral or tube feeding cannot maintain weight and hydration, surgeons place a central venous catheter (such as a tunneled line or port). This allows safe, repeated delivery of parenteral nutrition. It is done in the operating room or interventional radiology under sterile conditions. It is performed to prevent starvation and give the intestine time to heal while avoiding many repeated needle sticks.74
2. Gastrostomy or jejunostomy tube insertion
When long-term enteral feeding is needed, surgeons can place a feeding tube directly into the stomach (PEG) or small intestine (PEJ). The procedure is usually done under sedation using an endoscope and small incision. It is done to provide reliable access for nutrition and medicines in people who cannot swallow enough or who vomit easily but still have usable intestine for absorption.75
3. Segmental small-bowel resection
If a short segment of intestine is severely diseased, scarred, or bleeding, surgeons may remove that part and reconnect the healthy ends. This is done to remove a localized source of inflammation or obstruction. It is not a primary treatment for diffuse villous atrophy, but may be necessary for complications like strictures, fistulas, or tumors discovered during the work-up.76
4. Intestinal transplantation
In very rare, extreme cases where the intestine fails completely and long-term parenteral nutrition causes life-threatening complications, intestinal transplant (sometimes combined with liver) may be considered. Surgeons replace the diseased gut with donor intestine. This is done only in specialized centers because it requires lifelong immunosuppression and has significant risks, but it can restore nutritional independence in selected patients.77
5. Hematopoietic stem cell transplant procedure
As described above, HSCT is technically a transplant surgery plus chemotherapy and infusion. It is done to cure or greatly improve severe primary immunodeficiencies or some aggressive immune diseases that cause villous atrophy.72 After conditioning, donor stem cells are infused like a blood transfusion. The goal is long-term immune “reset,” which can indirectly cure gut symptoms.
Prevention tips
Treat and monitor celiac disease early. In people with celiac disease, strict lifelong gluten avoidance and regular follow-up reduce villous atrophy, malnutrition, and cancer risk.6
Avoid gut-damaging medicines when possible. Review drugs like NSAIDs, some blood pressure pills, and certain chemo or transplant drugs with a doctor to lower enteropathy risk.18
Use safe water and food hygiene. Clean water, careful cooking, and hand washing reduce intestinal infections that can trigger or worsen villous damage.19
Keep vaccinations up to date (as allowed by immune status). Vaccines against rotavirus, measles, influenza, and other infections reduce severe diarrhea episodes.19
Maintain good nutrition and weight. Balanced diets rich in protein, vitamins, and minerals help the gut recover faster from any injury.11
Manage chronic diseases like diabetes and autoimmune conditions. Keeping these under control reduces the chance of additional small-vessel and immune damage to the gut.2
Limit unnecessary antibiotics. Avoiding unneeded antibiotics helps protect healthy gut flora and reduces C. difficile risk.55
Seek early evaluation for persistent diarrhea (>4 weeks). Early testing for celiac disease, infections, and immune problems can catch villous atrophy before severe damage occurs.3
Protect bone health. Adequate vitamin D, calcium, and weight-bearing exercise reduce fractures related to malabsorption and steroids.62
Regular specialist follow-up if you have known villous atrophy. Routine monitoring allows early adjustment of diet, drugs, and supplements before major relapses happen.24
When to see a doctor
You should see a doctor as soon as possible if you have diarrhea lasting more than four weeks, especially if it comes with weight loss, night-time stools, pale bulky stools, or a family history of celiac disease, inflammatory bowel disease, or immune disorders.3 You also need urgent care if you notice blood in stool, severe tummy pain, fever, strong dizziness, very dry mouth, little urine, or black tarry stools.11
People already diagnosed with villous atrophy should contact their team quickly if diarrhea suddenly worsens, if they cannot keep fluids down, if they develop new swelling of legs or face, or if they have repeated infections. Children and teens with poor growth, delayed puberty, or behaviour changes with chronic diarrhea also need prompt specialist review.25
What to eat and what to avoid
Eat: small, frequent meals with soft, low-fat, high-protein foods (eggs, fish, tofu, lentils, yogurt) to support healing.11
Eat: gluten-free grains (rice, corn, millet, certified gluten-free oats) if celiac disease is present.6
Eat: peeled, well-cooked fruits and vegetables at first; raw salads can be added slowly as stools improve.3
Eat: healthy fats in small amounts, such as olive oil or MCT oil, to increase calories without overloading the gut.66
Drink: plenty of clean water and ORS during flares to avoid dehydration.60
Avoid: gluten (wheat, barley, rye) completely in confirmed or strongly suspected celiac disease.6
Avoid: very fatty, fried, or heavily spiced foods that often worsen loose stools.3
Avoid: large amounts of caffeine, alcohol, and fizzy drinks, which can irritate the gut and speed motility.11
Avoid or limit: lactose-rich foods (milk, ice-cream) if they clearly worsen symptoms; choose lactose-free options instead.8
Avoid: unpasteurized milk, unwashed raw vegetables, and street foods prepared in poor hygiene settings, especially in people with immune problems.19
Frequently asked questions
1. Is chronic diarrhea with villous atrophy always due to celiac disease?
No. Celiac disease is a common cause, but villous atrophy can also come from rare genetic diseases, autoimmune enteropathy, common variable immunodeficiency, infections, or drug reactions. A careful work-up with blood tests, stool tests, and biopsies is needed to find the true cause in each person.23
2. Can villi grow back once they are damaged?
Yes, in many cases villi can regrow if the underlying trigger is removed and the gut is protected. In celiac disease, a strict gluten-free diet often leads to near-normal villi over months to years. In immune or drug-related causes, controlling inflammation and adjusting medicines can also allow regeneration, although sometimes damage is long-standing.634
3. How long does it take for diarrhea to improve after starting treatment?
This varies a lot. Symptom drugs like loperamide may help within days, while diet changes and immune treatments may take weeks to months before a clear benefit is felt. Villi healing on biopsy usually lags behind symptom changes. Regular follow-up helps track progress and adjust the plan.2634
4. Can I just take antidiarrheal medicines without finding the cause?
Using antidiarrheals alone is not safe in the long term. They can hide serious disease and may be dangerous in infections like C. difficile or certain inflammatory conditions. Guidelines recommend first looking for causes such as celiac disease, bile acid diarrhea, infections, or immune problems, and using symptom medicines as part of a broader plan.315
5. Are probiotics safe for everyone with villous atrophy?
Probiotics are generally safe for healthy people, but in patients with severe immune deficiency or central lines, there is a small risk of bloodstream infection. Evidence for benefit in chronic diarrhea is mixed. Because of this, probiotics should only be used after discussion with the treating doctor, especially in CVID or other immunodeficiencies.1410
6. Will I need lifelong medicines?
Some people, like those with CVID or other primary immunodeficiencies, need lifelong treatments such as IVIG. Others may only need short or medium-term therapy while villi heal. Celiac disease requires lifelong gluten avoidance but not necessarily medicines. Your long-term plan depends on the exact diagnosis and your response to treatment.4720
7. Can children with this condition grow normally?
Yes, many children can reach normal height and weight if the cause is found early, nutrition is optimized, and the bowel is allowed to heal. Regular growth checks and bone monitoring are crucial, and sometimes extra calories, vitamins, and minerals are needed for catch-up growth.211
8. Is surgery always needed if I have villous atrophy?
No. Most people are treated medically with diet, drugs, and supplements. Surgery is reserved for complications like severe bleeding, obstruction, or complete intestinal failure. Even then, doctors weigh benefits and risks carefully before recommending procedures such as resections or transplants.7677
9. Can chronic diarrhea with villous atrophy be life-threatening?
It can become life-threatening if severe dehydration, sepsis, or extreme malnutrition develop, especially in infants and people with immune disorders. However, with early diagnosis, proper diet, rehydration, infection control, and, when needed, advanced therapies, many patients live long, active lives.112
10. Are there specific tests to diagnose bile acid diarrhea or bacterial overgrowth in this condition?
Yes. Doctors can use specialized tests such as SeHCAT scans or serum C4 for bile acid diarrhea, and breath tests or aspirate cultures for bacterial overgrowth. These tests guide use of bile acid binders or antibiotics instead of guessing, which improves safety and effectiveness.356
11. Does stress alone cause villous atrophy?
Stress alone does not flatten villi, but it can worsen symptoms in existing gut disease by changing motility and pain perception. Managing stress is an important supportive strategy, but structural damage in villous atrophy still needs medical treatment and good nutrition.16
12. Can I fast to “rest” my bowel?
Short periods of reduced intake may be used in hospital under supervision, but long self-directed fasting is usually harmful. It can worsen weight loss and micronutrient deficiency. The gut lining actually needs nutrients to repair; carefully chosen, small, frequent meals are usually better than prolonged fasting.1115
13. Are alternative or herbal remedies helpful?
Some herbal products may soothe mild diarrhea, but evidence in villous atrophy is very limited, and some herbs can interact with medicines or damage the liver or kidney. Always discuss any alternative treatments with your doctor, and do not stop proven therapies in favour of untested products.63
14. How often should I have follow-up tests?
This depends on the cause. In celiac disease, blood tests and sometimes repeat biopsy are done after 1–2 years on a gluten-free diet. In immune diseases or those needing strong medicines, blood counts, liver tests, and nutrient levels are checked regularly, often every 3–6 months. Your specialist will create a schedule based on your situation.2447
15. What is the most important thing I can do myself?
The most powerful things you can do are: follow your diet plan carefully, take medicines and supplements exactly as prescribed, drink enough safe fluids, and report any new or worrying symptoms early. Keeping a simple diary of food, stools, and symptoms helps you and your doctor see patterns and fine-tune treatment over time.223
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 22, 2026.
