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Intraepithelial lymphocytes in celiac disease

Teea T Järvinen1, Katri Kaukinen, Kaija Laurila

  • 1Department of Internal Medicine, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland.

The American Journal of Gastroenterology
|June 24, 2003
PubMed

Insights

Immunohistochemical analysis of intraepithelial lymphocytes (IELs) aids celiac disease (CD) diagnosis. Elevated gammadelta+ IELs specifically indicate CD, especially in difficult cases.

Area of Science:

  • Gastroenterology
  • Immunology
  • Histopathology

Background:

  • Celiac disease (CD) diagnosis can be challenging, necessitating refined diagnostic tools.
  • Intraepithelial lymphocytes (IELs) play a role in the immune response within the small intestine.
  • Understanding IEL subtypes may improve diagnostic accuracy for gastrointestinal disorders.

Purpose of the Study:

  • To evaluate the utility of immunohistochemical staining for different IEL subtypes in diagnosing celiac disease.
  • To assess the diagnostic performance (sensitivity and specificity) of CD3+, alphabeta+, and gammadelta+ IELs.
  • To correlate IEL counts with mucosal morphology and response to a gluten-free diet.

Main Methods:

  • A cohort of 928 adult patients suspected of having CD or being monitored for dietary compliance underwent endoscopy.
  • A control group of 59 adults with indigestion also underwent endoscopy.
  • Small bowel mucosal morphology and IEL populations (CD3+, alphabeta+, gammadelta+) were analyzed.

Main Results:

  • CD3+ and gammadelta+ IELs demonstrated high sensitivity (93%) for CD diagnosis.
  • gammadelta+ IELs showed superior specificity (88%) compared to CD3+ (73%) and alphabeta+ (66%) IELs.
  • Gluten-free diet led to mucosal recovery and decreased IEL densities, though gammadelta+ IELs remained elevated versus controls.

Conclusions:

  • Counting IELs, particularly gammadelta+ cells, is valuable in borderline or histologically ambiguous celiac disease cases.
  • Increased gammadelta+ IELs significantly strengthen the suspicion of celiac disease.
  • While informative, increased IELs are not universally present in all celiac disease patients.
Abstract

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