Redefining the intraepithelial lymphocytes threshold to diagnose gluten sensitivity in patients with architecturally normal duodenal histology
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Published on: December 15, 2011
S Pellegrino1, V Villanacci, N Sansotta
1Regional Celiac Center, Pad. NI, University Hospital G. Martino, via Consolare Valeria 1, Messina, Italy. fumonero@inwind.it
Insights
Accurate intraepithelial lymphocytes counts can diagnose mild coeliac disease enteropathy. Lowering the threshold for duodenal intraepithelial lymphocytes may improve detection rates in patients.
Area of Science:
- Gastroenterology
- Immunology
- Pathology
Background:
- Diagnosing mild coeliac disease enteropathy without villous atrophy is challenging.
- Previous studies may have used inappropriate controls, limiting the accuracy of intraepithelial lymphocytes (IELs) counts.
Purpose of the Study:
- To assess the diagnostic accuracy of IELs counts.
- To utilize controls lacking coeliac disease-associated HLA alleles (HLA-DQ2/DQ8).
Main Methods:
- IELs were counted at the villus tip and per 100 enterocytes using H&E and CD3 staining.
- The study included 29 patients with potential or latent coeliac disease and 14 controls lacking HLA-DQ2/DQ8.
Main Results:
- Normal IEL thresholds in controls were established (e.g., 3.5 at villus tip/H&E).
- High sensitivity (90-93%) and specificity (100%) were observed for IELs counts in detecting mild coeliac disease enteropathy.
- A threshold of 25 IELs/100 enterocytes could miss a significant percentage of cases.
Conclusions:
- IELs counts are feasible diagnostic tools for mild coeliac disease enteropathy.
- The current accepted threshold for duodenal IELs may need to be lowered for improved diagnostic accuracy.
Background:
Accuracy of intraepithelial lymphocytes counts for diagnosing mild enteropathy coeliac disease in absence of villous atrophy can be limited by inappropriate controls included in the studies.
Aim:
To determine the diagnostic accuracy of intraepithelial lymphocytes counts utilising controls lacking HLA coeliac disease-associated alleles.
Methods:
Intraepithelial lymphocytes counting at villus tip and per 100 enterocytes was performed at haematoxylin and eosin (H&E) and CD3-stainings in: 29 cases (21 with potential coeliac disease and 8 affected by latent coeliac disease) representing the patient population and 14 noncoeliac controls lacking HLA-DQ2/DQ8 alleles.
Results:
Threshold (mean+2 s.d.) of duodenal intraepithelial lymphocytes at villus tip and per 100 enterocytes in noncoeliac controls was respectively: 3.5 and 18 at H&E, 3.2 and 17 following CD3-staining. Considering the whole patient population, the sensitivity of tip intraepithelial lymphocytes in detecting mild enteropathy coeliac disease was 90% (95% CI=72.6-97.8) both at H&E and CD3-stainings. The sensitivity of intraepithelial lymphocytes per 100 enterocytes was 93% (95% CI=77.2-99.2) both at H&E and CD3-staining. Specificity of both intraepithelial lymphocytes counts was 100% (95% CI=76.8-100). Using a threshold of 25 intraepithelial lymphocytes per 100 enterocytes could miss 59% of cases at H&E and 48% following CD3-staining.
Conclusions:
Intraepithelial lymphocytes counts are diagnostic feasible tools to detect mild enteropathy coeliac disease. Threshold of duodenal intraepithelial lymphocytes may be lower than currently accepted.
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