If intestinal biopsies and histopathology are consistent with CIE, what should you do next?

• A. Begin antibiotics
• B. Trial steroids
• C. Schedule surgical removal
• D. Continue diet alone

Answer: (B)

When biopsy and histopathology show chronic inflammatory enteropathy, the inflammation is immune-mediated rather than simply caused by infection or a structural lesion. The most appropriate next step is anti-inflammatory therapy to suppress the mucosal immune response, and corticosteroids are the standard first-line option because they rapidly reduce intestinal inflammation and lead to clinical and histologic improvement. Starting steroids targets the underlying inflammatory process and helps control chronic diarrhea, weight loss, and other signs. Relying on diet alone is less likely to resolve active inflammation once histology confirms CIE, and antibiotics address bacteria rather than the immune-driven inflammation. Surgical removal isn’t indicated for diffuse inflammatory disease. If steroids control the disease, tapering over time is used; if response is limited or relapses occur, additional immunosuppressants may be considered.