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Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease?
F Biagi1, O Luinetti, J Campanella
1Gastroenterology Unit, University of Pavia, 27100 Pavia, Italy. f.biagi@smatteo.pv.it
Insights
Counting intraepithelial lymphocytes (IELs) in duodenal villous tips can distinguish potential celiac disease (PCD) patients from controls. This simple method aids in diagnosing gluten sensitivity in those with normal duodenal mucosa.
Area of Science:
- Gastroenterology
- Immunology
- Histopathology
Background:
- Counting intraepithelial lymphocytes (IELs) in villous tips of normal small bowel biopsies was proposed for measuring mucosal infiltration in gluten-sensitive individuals.
- This study evaluates the utility of IEL counting in architecturally normal duodenal biopsies.
Purpose of the Study:
- To assess if counting intraepithelial lymphocytes (IELs) in duodenal biopsy villous tips can differentiate potential celiac disease (PCD) patients from controls.
- To validate a straightforward method for diagnosing gluten sensitivity.
Main Methods:
- Duodenal biopsy sections from 11 potential celiac disease (PCD) patients, 19 treated celiac disease (TCD) patients, and 17 controls were stained for CD3+ IELs.
- IELs per 20 enterocytes were counted in five villous tips per patient under blind examination.
- PCD patients were on a gluten-containing diet, had normal duodenal mucosa, and were endomysial antibody positive.
Main Results:
- Mean villous tip IEL scores were 4.6 in controls, 7.9 in TCD patients, and 9.2 in PCD patients.
- A significant difference was observed between PCD patients and non-celiac controls.
- The IEL count in villous tips showed higher values in PCD patients compared to controls.
Conclusions:
- Counting intraepithelial lymphocytes (IELs) in villous tips is a simple and reliable method.
- This technique aids in distinguishing potential celiac disease (PCD) patients from non-celiac controls when duodenal mucosa appears architecturally normal.
Background:
The counting of intraepithelial lymphocytes (IELs) in the villous tips of architecturally normal small bowel biopsy specimens was proposed as a method to measure mucosal infiltration in gluten sensitive patients.
Aims:
To apply this straightforward method in duodenal biopsy specimens from patients affected by potential coeliac disease (PCD) to verify whether it can discriminate these patients from controls.
Methods:
Paraffin wax embedded duodenal sections from 11 patients affected by PCD were stained with an antihuman CD3 antibody. Sections from 19 patients affected by treated coeliac disease (TCD) and 17 patients in whom coeliac disease was excluded were stained with the same antibody to serve as controls. The slides were examined blindly. IELs/20 enterocytes in five randomly chosen villous tips were counted. Patients affected by PCD were all on a gluten containing diet. They had an architecturally normal duodenal mucosa and were positive for endomysial antibody. Both TCD and non-coeliac controls were negative for endomysial antibody.
Results:
The mean villous tip IEL scores were 4.6 (SD, 1.5; range, 1.4-7.8) in non-coeliac controls, 7.9 (SD, 4.0; range, 2.0-18.6) in TCD, and 9.2 (SD, 4.7; range, 5.8-21.8) in patients with PCD. The difference between PCD and non-coeliac controls was significant.
Conclusions:
This is a very simple and sufficiently reliable method to count IELs. In patients with an architecturally normal duodenal mucosa, the IEL count in villous tips helps to distinguish between patients with PCD and non-coeliac controls.
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