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Quantitation of intraepithelial lymphocytes in human duodenum: what is normal?
1Centre for Digestive Diseases, General Infirmary at Leeds, Leeds LS1 3EX, UK. mumtaz@supnet.com
Insights
The normal range for intraepithelial lymphocytes (IELs) in duodenal biopsies is lower than previously thought. This study establishes a new upper limit of 25 IELs per 100 epithelial cells for diagnosing coeliac disease.
Area of Science:
- Gastroenterology
- Histopathology
- Immunology
Background:
- Intraepithelial lymphocytes (IELs) are crucial for diagnosing coeliac disease (CD).
- Current diagnostic criteria rely on outdated IEL counts from jejunal biopsies (upper limit 40/100 cells).
- Duodenal biopsies are the standard for CD diagnosis.
Purpose of the Study:
- To determine the normal range of IEL counts in distal duodenal biopsies.
- To establish an updated upper limit for IELs in duodenal mucosa.
Main Methods:
- Analyzed distal duodenal biopsies from 20 healthy subjects.
- Quantified IELs and epithelial cells in villous epithelium.
- Assessed villous architecture using villous height to crypt depth ratio.
Main Results:
- The range of IEL counts was 1.8-26/100 epithelial cells (mean 11, SD 6.8).
- No correlation was found between IEL counts and villous to crypt ratio.
- The mean villous to crypt ratio was 1.82.
Conclusions:
- The upper limit of normal for duodenal IELs should be revised.
- Suggests 25 IELs/100 epithelial cells (mean +2 SD) as the new upper limit.
- This revised range aids in accurate coeliac disease diagnosis.
Background:
An increase in intraepithelial lymphocytes (IELs) is mandatory for the histological diagnosis of coeliac disease (CD). Currently, duodenal biopsies are used almost exclusively to establish the diagnosis, yet published work continues to cite an upper limit of 40 lymphocytes/100 epithelial cells, a figure derived from jejunal biopsies over 30 years ago.
Aim:
To establish the normal range for IEL counts in distal duodenal biopsies.
Materials/Methods:
Twenty subjects (seven men, 13 women; median age, 34 years; range, 20-65) with a normal sugar permeability test and concurrent distal duodenal biopsies were identified. The number of IELs and epithelial cell nuclei in an uninterrupted length of surface (villous) epithelium (> 500 cells) was counted. An image analysis system was used to assess villous architecture by calculating the villous height to crypt depth ratio.
Results:
The range of IEL counts in 20 subjects was 1.8-26/100 villous epithelial cells, with a mean value of 11 and SD of 6.8. The mean villous to crypt ratio was 1.82 (SD, 0.38; range, 1.22-2.46). There was no correlation between IEL counts and villous to crypt ratio (Spearman rank correlation, -0.066; p = 0.80).
Conclusions:
These results suggest that 25 IELs/100 epithelial cells (mean +2 SD) should be taken as the upper limit of the normal range for duodenal mucosa.