Gastrointestinal manifestations of common variable immunodeficiency: what a gastroenterologist needs to be aware of.

INTRODUCTION: Common variable immunodeficiency disorder (CVID) is the most common symptomatic primary immunodeficiency disorder and, given its predilection to affect the gastrointestinal (GI) tract, will be encountered in the practice of a general gastroenterologist, as well as those with more focused interests. AREAS COVERED: Gastrointestinal and hepatic manifestations of CVID - their clinical presentation, endoscopic, imaging and pathological features. Also reviewed, in detail, diagnostic and therapeutic issues that the clinician may be confronted with in dealing with these disorders. EXPERT OPINION: Among the protean GI manifestations of CVID a predisposition to enteric infections, chronic gastritis, enteropathy and a form of inflammatory bowel disease feature prominently. Each poses diagnostic and therapeutic challenges; differentiation from celiac disease, Crohn's disease and ulcerative colitis may be challenging, emphasizing the need for awareness of the possibility of CVID when clinical features are atypical. The liver may also be involved, and the gastroenterologist needs to be especially aware of the higher prevalence of gastrointestinal cancer in this patient population.