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Duodenal lymphogram as a complementary tool in the diagnosis of celiac disease in adults
Beatriz Burgueño Gómez1, Celia Escudero-Hernández2, Rodrigo de Pedro3
1Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, España.
Insights
The duodenal lymphogram, a flow cytometry technique, reliably aids in diagnosing celiac disease (CD) in adults. While effective, adherence to a gluten-free diet (GFD) and other factors can influence its diagnostic accuracy.
Area of Science:
- Gastroenterology
- Immunology
- Diagnostic Medicine
Background:
- Celiac disease (CD) is characterized by specific duodenal lymphocytic infiltrates.
- Flow cytometry, termed lymphogram, quantifies intraepithelial lymphocytes (IELs) for CD diagnosis.
- This study details the experience with lymphograms in adult CD diagnosis.
Purpose of the Study:
- To evaluate the reliability of the duodenal lymphogram as a diagnostic tool for celiac disease in adults.
- To assess the association of lymphogram results with CD diagnosis, gluten-free diet (GFD) compliance, and disease duration.
Main Methods:
- Retrospective analysis of 157 lymphograms from 2009-2017.
- Categorization of patients into diagnosed CD (on GFD or new diagnosis) and non-celiac groups.
- Determination of correlations between lymphogram parameters (IELs, CD3-, TcRγδ lymphocytes) and clinical factors (GFD compliance, IgA anti-TG2).
Main Results:
- TcRγδ lymphocytes showed diagnostic utility for CD (ROC curve 0.86).
- GFD-treated CD patients had lower TcRγδ percentages (12% vs. 20.5%, p=0.0153) but remained higher than non-CD controls.
- Disease duration and IgA anti-TG2 titers correlated with lymphogram findings; H. pylori and ARA2 treatment affected non-CD lymphograms.
Conclusions:
- The duodenal lymphogram is a dependable complementary diagnostic method for adult celiac disease.
- Diagnostic capacity can be influenced by GFD adherence, duration, and other patient-specific factors.
Introduction:
celiac disease (CD) patients have a specific pattern of lymphocytic infiltrate in the duodenal mucosa. Flow cytometry is a complementary tool for the diagnosis of CD, which allows the quantification and characterization of intraepithelial lymphocytes (IELs) by what is commonly called a lymphogram. Here we describe our experience with this technique in the diagnosis of CD in adult patients.
Methods:
lymphograms from 157 patients performed in our center between 2009 and 2017 were retrospectively analyzed. Fourteen patients had a previous diagnosis of CD and followed a gluten-free diet (GFD), 21 had a new diagnosis of CD and the remaining were considered as non-celiac. The association of the lymphogram results (total IELs, CD3- lymphocytes and TcRγδ lymphocytes) with the CD diagnosis, compliance with the GFD, time since diagnosis and IgA anti-TG2 titer were determined.
Results:
the area under the ROC curve of TcRγδ lymphocytes for CD patients varied between 0.86 and 0.86. The percentage of TcRγδ lymphocytes in GFD-treated patients was lower; 12 (8.5) vs 20.5 (8.7), p = 0.0153. However, it remained high compared to non-CD; 12 (8.5) vs 6.7 (6), p = 0.135. The time since diagnosis and IgA anti-TG2 titer correlated with the lymphogram results. Helicobacter pylori infection and treatment with angiotensin receptor antagonist 2 (ARA2) were associated with differences in the lymphogram results in patients without CD.
Conclusions:
the duodenal lymphogram is a reliable complementary tool in adults for the diagnosis of CD. However, compliance and duration of the GFD and other factors may condition its diagnostic capacity.
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