Intraepithelial lymphocytes and coeliac disease

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.