Duodenal histology in patients with celiac disease after treatment with a gluten-free diet

Lee, Susie K.; Lo, Wayne; Memeo, Lorenzo; Rotterdam, Heidrun; Green, Peter H.R.

doi:10.1067/mge.2003.54

Cited by 205 publications

(147 citation statements)

References 32 publications

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“…Other reports have used counts 430 lymphocytes/100 epithelial cells to 'arbitrarily' define elevations of intraepithelial lymphocytes. 35,36 Mahadeva et al 25 lymphocytes/100 epithelial cells was chosen as the upper limit of normal in our study, as we have observed that an increase above this level correlates well with the subjective visual impression of an elevation in intraepithelial lymphocytes (unpublished observations) and because we and others 35 have observed that not only individuals with latent or treated celiac disease but even symptomatic patients can, at times, present with only mild elevations of intraepithelial lymphocytes (see below). The histologic changes in biopsies from such patients are not sufficient to make the diagnosis of celiac disease according to the established criteria 37 and the interpretation of these biopsies is further compounded by the fact that serologic tests are often negative at this stage.…”

Section: Discussionmentioning

confidence: 71%

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

et al. 2005

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We have observed expansions of intraepithelial lymphocytes in duodenal biopsies from patients with Helicobacter pylori gastritis. This study was undertaken to prospectively evaluate, unselected, paired gastric and duodenal biopsies from 50 patients with H. pylori gastritis and a comparison group of 30 patients with other types of gastritis (10 autoimmune and 20 reactive) to: (1) quantify duodenal intraepithelial lymphocytes, determine their distribution patterns, epithelial location, and phenotype, and (2) correlate the intraepithelial lymphocyte elevations with various features of gastric and duodenal pathology. Intraepithelial lymphocytes were analyzed with antibodies including CD3, CD8, and TIA-1. A stain for H. pylori was performed on all gastric and duodenal biopsies. Duodenal intraepithelial lymphocytes from patients with H. pylori gastritis (using CD3) ranged from 3 to 42 lymphocytes/100 epithelial cells (mean 18.5) compared to 3 to 18 lymphocytes/100 epithelial cells (mean 6.6) in the comparison group. Intraepithelial lymphocyte elevations were seen in 44% of the duodenal biopsies from patients with H. pylori gastritis (using CD3). Significant differences in the intraepithelial lymphocyte counts between patients with H. pylori gastritis and the comparison group were seen for all three T-cell antigens (Po0.001 for CD3 and CD8 and Po0.002 for TIA-1). Duodenal intraepithelial lymphocytes in the H. pylori þ cases had a latent cytotoxic phenotype, H. pylori was not visualized in any of the duodenal biopsies from patients with H. pylori gastritis, and no patient had clinical evidence of celiac disease. Our study highlights frequent duodenal intraepithelial lymphocytosis in individuals with H. pylori gastritis and the lymphocyte distribution patterns (and numbers) overlapped with those described for celiac disease patients. H. pylori gastritis must be considered as a possible explanation for duodenal intraepithelial lymphocytosis with normal villous architecture, especially when lymphocytosis is patchy, intraepithelial lymphocytes display a 'latent' cytotoxic phenotype, and the clinical findings and serologic profile does not fit celiac disease.

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Section: Discussionmentioning

confidence: 71%

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

et al. 2005

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“…However it is not clear if biopsy provides a better assessment of long-term adherence than nutritionist evaluation. In fact, prior studies showed only a modest correlation of histology with clinical presentation or assessed dietary adherence [17,33]. Although for brevity, in the nutritionist evaluation found in Appendix 1, only frequency is noted, the evaluation was designed to be standardized, dynamic, and comprehensive.…”

Section: Discussionmentioning

confidence: 99%

Factors that Influence Adherence to a Gluten-Free Diet in Adults with Celiac Disease

et al. 2007

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Objective-The only treatment for celiac disease is lifelong adherence to a gluten-free diet, yet adherence is limited and factors influencing adherence are poorly understood. The purpose of this study was to determine factors influencing gluten-free diet adherence in adults with celiac disease.Methods-A questionnaire was developed and administered to 154 adults with celiac disease who then underwent a standardized gluten-free diet evaluation by an experienced nutritionist. Multivariate analysis was conducted to determine factors associated with adherence level.Results-Thirteen factors hypothesized to contribute to gluten-free diet adherence were found to be significantly associated with improved adherence including: understanding of the gluten-free diet, membership of a celiac disease advocacy group, and perceived ability to maintain adherence despite travel or changes in mood or stress (P < 0.001). Conclusions-This study identified specific factors correlated with gluten-free diet adherence. These results provide a foundation for the design of educational interventions to improve adherence. NIH Public Access

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“…However, this feature should be interpreted in the context of other clinical, serological and histological variables, as patients on gluten-free diet often lack increased intraepithelial lymphocytes. 35 Conversely, before attributing increased intraepithelial lymphocytes to underlying celiac disease, other mimics of celiac disease, which have also been implicated as etiologic agents of collagenous sprue, such as tropical sprue, common variable immunodeficiency and autoimmune enteropathy, should be excluded. 17,18,36 Unusual histological features observed in our patients with unclassified sprue, included a peculiar pattern of crypt destruction, reminiscent of graft-versus-host disease, accompanied by a granulomatous reaction and nodular lymphoid hyperplasia, which can also be seen in small bowel biopsies from individuals with common variable immunodeficiency.…”

Section: Discussionmentioning

confidence: 99%

Collagenous sprue is not always associated with dismal outcomes: a clinicopathological study of 19 patients

et al. 2010

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Collagenous sprue is associated with high morbidity; however, the etiology of this disorder is unclear. Data regarding the pathological and clinical manifestations of patients with collagenous sprue are also limited. We, thus, undertook this study to gain insight into the etiology, disease manifestations and outcomes of collagenous sprue. We searched our departmental database (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) to identify cases of collagenous sprue and to obtain clinical and laboratory data. Small bowel histology, including thickness of subepithelial collagen, intra-epithelial lymphocyte phenotype and results of T-cell clonality assays were evaluated. Nineteen patients (15 women, 4 men, age 22-80 years, mean 57 years) were identified.

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Duodenal histology in patients with celiac disease after treatment with a gluten-free diet

Cited by 205 publications

References 32 publications

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

Factors that Influence Adherence to a Gluten-Free Diet in Adults with Celiac Disease

Collagenous sprue is not always associated with dismal outcomes: a clinicopathological study of 19 patients

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