Histopathological evaluation of duodenal biopsy in the PreventCD project. An observational interobserver agreement study

Villanacci, Vincenzo; Lorenzi, Luisa; Donato, Francesco; Auricchio, Renata; Dziechciarz, Piotr; Gyimesi, Judit; Koletzko, Sibylle; Mišak, Zrinjka; Laguna, Vanesa Morente; Polanco, Isabel; Ramos, David; Shamir, Raanan; Troncone, Riccardo; Vriezinga, Sabine L.

doi:10.1111/apm.12812

Cited by 22 publications

(14 citation statements)

References 28 publications

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“…It is a matter of debate if a reference pathologist should be consulted in contradictory cases. This claim is substantiated by data revealing a high interobserver variability in histopathology [ 55 , 56 , 57 ].…”

Section: Gluten-free Diet In Potential Celiac Diseasementioning

confidence: 84%

Gluten-Free Diet in Celiac Disease—Forever and for All?

et al. 2018

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The gluten-free diet is the only effective treatment available for celiac disease. However, it is difficult to adhere to and a closer look on the diet’s implementation and indications reveals several ambiguities: Not only is there controversy on the threshold of gluten that can be tolerated in the frame of a strict gluten-free diet, but it is also unclear whether the gluten-free diet is an appropriate treatment in patient subgroups with asymptomatic or potential celiac disease. Reports from a number of research groups suggest that a certain proportion of patients may effectively develop tolerance to gluten and thus become suitable for gluten reintroduction over time. In this review, we set out to create an overview about the current state of research as regards the definition of a strict gluten-free diet in terms of the gluten thresholds considered tolerable and the indication for a gluten-free diet in the absence of histological abnormalities or symptoms. Furthermore, we discuss the concept that a gluten-free diet must be followed for life by all patients.

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Section: Gluten-free Diet In Potential Celiac Diseasementioning

confidence: 84%

Gluten-Free Diet in Celiac Disease—Forever and for All?

et al. 2018

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“…Diagnostic difficulties may arise, however, when serology and biopsy findings are borderline. In such cases, there is significant interobserver variation between pathologists, and risk for both under-and overdiagnosis [5][6][7][8]. Histological findings may show celiac disease-unrelated inflammation (e.g., due to non-specific duodenitis, Helicobacter infection, or olmesartan use).…”

Section: Introductionmentioning

confidence: 99%

A New Intraepithelial γδ T-Lymphocyte Marker for Celiac Disease Classification in Formalin-Fixed Paraffin-Embedded (FFPE) Duodenal Biopsies

et al. 2020

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Background The histopathologic diagnosis of celiac disease (CD) may be challenging when the duodenal biopsies mucosal injury is limited. Intraepithelial T-lymphocytes (IELs) can be useful to characterize the degree of mucosal inflammation. A small fraction of IELs expresses the γδ T-cell receptor (named γδ-IELs), whose density, determined by flow cytometry or frozen section immunohistochemistry (IHC), is a specific marker for CD. Aim To establish a new IHC assay for γδ-IELs applicable to formalin-fixed paraffin-embedded (FFPE) duodenal biopsies. Methods We analyzed γδ-IELs using IHC in 138 duodenal biopsies using a standard IHC staining protocol with a new monoclonal antibody H-41. IELs were quantitated with digital image analysis. Results Compared to those in non-celiac controls (n = 51), γδ-IEL density was significantly increased in newly diagnosed celiac disease patients (n = 22, p < 0.0001). In ROC-curve analysis, the cutoff of 6.5 γδ-IELs/100 enterocytes distinguished optimally active CD patients from non-celiac controls (sensitivity 96%, specificity 95%). γδ-IEL density in CD patients on a gluten-free diet (n = 53) were also higher than in controls (p < 0.0001), but lower than those in newly diagnosed CD (p < 0.0001). The diagnostic value of γδ-IELs outperformed that of CD3 + IELs in both patient groups. γδ-IELs were better than CD3 + IELs distinguishing between celiac disease and conditions histologically mimicking celiac disease (n = 12). Conclusions Intraepithelial γδ T-lymphocytes can be stained and quantitated reliably in FFPE duodenal biopsies. The results showed excellent specificity and sensitivity for celiac disease. The new IHC method of detection of γδ-IELs is a promising addition to the routine histopathologic assessment methodology of celiac disease.

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“…Future studies may be able to assess GFD adherence objectively through the presence of gluten immunogenic peptides in the urine[ 14 ]. There is also the possibility that variation in pathology assessment and reporting may influence inter center results; although, good interobserver agreement for the detection of villous atrophy has been reported[ 15 ]. In addition, the majority of patients included in this study were diagnosed on the basis of symptoms, with approximately 12% diagnosed by screening alone.…”

Section: Discussionmentioning

confidence: 99%

Understanding celiac disease monitoring patterns and outcomes after diagnosis: A multinational, retrospective chart review study

Lundin¹,

Kelly²,

Sanders³

et al. 2021

WJG

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BACKGROUND Long-term outcomes and monitoring patterns in real-world practice are largely unknown among patients with celiac disease. AIM To understand patterns of follow-up and management of patients with celiac disease, and to characterize symptoms and villous atrophy after diagnosis. METHODS A retrospective chart review study was performed using medical chart data of patients diagnosed with celiac disease. Three gastroenterology referral centers, with substantial expertise in celiac disease, participated in the United Kingdom, United States, and Norway. Demographic and clinical data were collected from medical charts. Descriptive analyses were conducted on patients with biopsy-confirmed celiac disease, diagnosed between 2008 and 2012, with at least one follow-up visit before December 31, 2017. Patient demographic and clinical characteristics, biopsy/serology tests and results, symptoms, and comorbidities were captured at diagnosis and for each clinic visit occurring within the study period ( i.e. , before the study end date of December 31, 2017). RESULTS A total of 300 patients were included in this study [72% female; mean age at diagnosis: 38.9 years, standard deviation (SD) 17.2]. Patients were followed-up for a mean of 29.9 mo (SD 22.1) and there were, on average, three follow-up visits per patient during the study period. Over two-thirds (68.4%) of patients were recorded as having ongoing gastrointestinal symptoms and 11.0% had ongoing symptoms and enteropathy during follow-up. Approximately 80% of patients were referred to a dietician at least once during the follow-up period. Half (50.0%) of the patients underwent at least one follow-up duodenal biopsy and 36.6% had continued villous atrophy. Patterns of monitoring varied between sites. Biopsies were conducted more frequently in Norway and patients in the United States had a longer follow-up duration. CONCLUSION This real-world study demonstrates variable follow-up of patients with celiac disease despite most patients continuing to have abnormal histology and symptoms after diagnosis.

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Histopathological evaluation of duodenal biopsy in the PreventCD project. An observational interobserver agreement study

Cited by 22 publications

References 28 publications

Gluten-Free Diet in Celiac Disease—Forever and for All?

Gluten-Free Diet in Celiac Disease—Forever and for All?

A New Intraepithelial γδ T-Lymphocyte Marker for Celiac Disease Classification in Formalin-Fixed Paraffin-Embedded (FFPE) Duodenal Biopsies

Understanding celiac disease monitoring patterns and outcomes after diagnosis: A multinational, retrospective chart review study

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