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Intraepithelial lymphocytes and coeliac disease
Pekka Collin1, Peter J Wahab, Joseph Anthony Murray
1Tampere University Hospital and University of Tampere, University of Tampere, FIN-33014 Tampere, Finland. pekka.collin@uta.fi
Best Practice & Research. Clinical Gastroenterology
|June 1, 2005
Summary
Diagnosing coeliac disease can be challenging due to subtle symptoms and non-specific histologic findings. A comprehensive approach combining clinical history, histology, serology, and gluten challenge is crucial for accurate diagnosis.
Area of Science:
- Gastroenterology
- Immunology
- Pathology
Background:
- Coeliac disease diagnosis is straightforward with clear symptoms and villous atrophy.
- Subtle symptoms and borderline histologic findings complicate early coeliac disease diagnosis.
- Increased intraepithelial lymphocytes are common but unspecific in coeliac disease.
Purpose of the Study:
- To outline diagnostic challenges in coeliac disease.
- To emphasize the need for a multi-faceted diagnostic approach.
- To differentiate early coeliac disease from non-specific histologic changes.
Main Methods:
- Review of diagnostic criteria for coeliac disease.
- Analysis of serological markers (anti-endomysium, anti-tissue transglutaminase antibodies).
- Evaluation of histologic findings (villous atrophy, intraepithelial lymphocytes).
- Consideration of human leukocyte antigen (HLA) DQ2/DQ8 associations.
- Assessment of gluten-dependency through dietary intervention and challenge.
Main Results:
- Increased intraepithelial lymphocytes, including gammadelta+ T cells, are characteristic but not definitive.
- Specific antibodies (IgA class anti-endomysium, anti-tissue transglutaminase) increase diagnostic likelihood.
- HLA DQ2/DQ8 absence strongly argues against coeliac disease; presence has limited diagnostic value.
- Gluten-dependency is key in borderline cases.
Conclusions:
- No single test reliably diagnoses early coeliac disease.
- Accurate diagnosis requires integrating clinical presentation, histology, serology, and gluten challenge.
- A comprehensive diagnostic work-up is essential for coeliac disease management.