Lymphocytic duodenosis: Aetiology and long-term response to specific treatment

Rosinach, Mercé; Esteve, María; González, Clarisa; Temiño, Rocío; Mariné, Meritxell; Monzón, Helena; Sainz, Empar; Loras, Carme; Espinós, Jorge C.; Forné, M; Viver, Josep Maria; Salas, Antonio; Fernández‐Bañares, Fernando

doi:10.1016/j.dld.2012.03.006

Cited by 37 publications

(38 citation statements)

References 27 publications

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“…Indeed other prospective studies have subsequently confirmed celiac disease in only 16% of unselected patients 24 and 43.3% of patients with HLA DQ2 or DQ8. 25 Furthermore much of the evidence for the diagnosis of celiac disease based on Marsh 1 changes alone is based on a single study of just 23 EMA positive patients. 26 This cohort of patients demonstrated significant improvement in symptoms and antibody titers on a gluten free diet.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Immunologic Features of Ultra-Short Celiac Disease

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Clinical and Immunologic Features of Ultra-Short Celiac Disease

et al. 2016

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“…However, it is not in itself sufficient for a definitive diagnosis of CD, as other pathologies may present in the same manner [3]–[5]. In this sense, other diagnostic approaches beyond conventional histology have been introduced for diagnosis of CD in the presence of a Marsh 1 lesion [6], [7].…”

Section: Introductionmentioning

confidence: 99%

“…However, it is well known that the sensitivity of celiac serology in Marsh type 1 lesion is low, [3], [8], [26], [27] and that when positive, a diagnosis of CD is generally definitive. To our knowledge, the reliability of IEL pattern analysis by flow cytometry in seronegative lymphocytic enteritis has not been investigated, and these are the challenging cases for CD diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Intestinal Intraepithelial Lymphocyte Cytometric Pattern Is More Accurate than Subepithelial Deposits of Anti-Tissue Transglutaminase IgA for the Diagnosis of Celiac Disease in Lymphocytic Enteritis

et al. 2014

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Background & AimsAn increase in CD3+TCRγδ+ and a decrease in CD3− intraepithelial lymphocytes (IEL) is a characteristic flow cytometric pattern of celiac disease (CD) with atrophy. The aim was to evaluate the usefulness of both CD IEL cytometric pattern and anti-TG2 IgA subepithelial deposit analysis (CD IF pattern) for diagnosing lymphocytic enteritis due to CD.MethodsTwo-hundred and five patients (144 females) who underwent duodenal biopsy for clinical suspicion of CD and positive celiac genetics were prospectively included. Fifty had villous atrophy, 70 lymphocytic enteritis, and 85 normal histology. Eight patients with non-celiac atrophy and 15 with lymphocytic enteritis secondary to Helicobacter pylori acted as control group. Duodenal biopsies were obtained to assess both CD IEL flow cytometric (complete or incomplete) and IF patterns.ResultsSensitivity of IF, and complete and incomplete cytometric patterns for CD diagnosis in patients with positive serology (Marsh 1+3) was 92%, 85 and 97% respectively, but only the complete cytometric pattern had 100% specificity. Twelve seropositive and 8 seronegative Marsh 1 patients had a CD diagnosis at inclusion or after gluten free-diet, respectively. CD cytometric pattern showed a better diagnostic performance than both IF pattern and serology for CD diagnosis in lymphocytic enteritis at baseline (95% vs 60% vs 60%, p = 0.039).ConclusionsAnalysis of the IEL flow cytometric pattern is a fast, accurate method for identifying CD in the initial diagnostic biopsy of patients presenting with lymphocytic enteritis, even in seronegative patients, and seems to be better than anti-TG2 intestinal deposits.

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“…Indeed, a prospective study of the aetiology of LE in 100 patients estimated that at least 16% of patients with this condition may actually have CD [11]. However, a more recent Spanish prospective study of 90 consecutive patients with LE and clinical symptoms of CD reached a final diagnosis of gluten-sensitive enteropathy (GSE), alone or associated with Helicobacter pylori (HP) infection, in 43% of patients [12]. In addition to gluten sensitivity, LE may be related to non-steroidal anti-inflammatory drug (NSAID) intake, intolerance to non-gluten food protein (for example, cow’s milk, eggs, peanuts, soya), autoimmune disorders (for example, thyroiditis, type I diabetes, rheumatoid arthritis, psoriasis, multiple sclerosis, systemic lupus erythematosus), inflammatory and infectious intestinal tract disorders (for example, Crohn’s disease, bacterial overgrowth, HP, tropical sprue, and Giardia lamblia , Cryptosporidium and viral infections), and T-cell intestinal lymphoma [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to gluten sensitivity, LE may be related to non-steroidal anti-inflammatory drug (NSAID) intake, intolerance to non-gluten food protein (for example, cow’s milk, eggs, peanuts, soya), autoimmune disorders (for example, thyroiditis, type I diabetes, rheumatoid arthritis, psoriasis, multiple sclerosis, systemic lupus erythematosus), inflammatory and infectious intestinal tract disorders (for example, Crohn’s disease, bacterial overgrowth, HP, tropical sprue, and Giardia lamblia , Cryptosporidium and viral infections), and T-cell intestinal lymphoma [13,14]. Two or more aetiological factors are often associated, the most frequent of these being NSAIDs, CD and HP infection [11,12]. …”

Section: Introductionmentioning

confidence: 99%

Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case-control study

et al. 2014

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IntroductionIrritable bowel syndrome (IBS), lymphocytic enteritis (LE) and fibromyalgia syndrome (FMS) are three common disorders. Since a gluten-free diet (GFD) has been shown to be helpful in LE, we aimed to assess its effect in a series of LE patients also diagnosed with IBS and FMS.MethodsThe study sample comprised 97 IBS plus FMS adult females, of whom 58 had LE (Marsh stage 1), and 39 had a normal duodenal biopsy (Marsh stage 0). All patients fulfilled the Rome III and American College of Rheumatology 1990 criteria. All participants followed a GFD, the effectiveness of which was assessed by changes in the results of several tests, including those of the Fibromyalgia Impact Questionnaire (FIQ), the Health Assessment Questionnaire (HAQ), tender points (TPs), the Short Form Health Survey (SF-36), and the Visual Analogue Scales (VAS) for gastrointestinal complaints, pain and fatigue.ResultsAt baseline, all patients had a poor quality of life (QoL) and high VAS scores. After one year on a GFD, all outcome measures were somewhat better in the Marsh stage 1 group, with a mean decrease of 26 to 29% in the TPs, FIQ, HAQ and VAS scales, accompanied by an increase of 27% in the SF-36 physical and mental component scores. However, in the IBS plus FMS/Marsh stage 0 group, the GFD had almost no effect.ConclusionsThis pilot study shows that a GFD in the LE-related IBS/FMS subgroup of patients can produce a slight but significant improvement in all symptoms. Our findings suggest that further studies of this subject are warranted.

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Lymphocytic duodenosis: Aetiology and long-term response to specific treatment

Cited by 37 publications

References 27 publications

Clinical and Immunologic Features of Ultra-Short Celiac Disease

Clinical and Immunologic Features of Ultra-Short Celiac Disease

Intestinal Intraepithelial Lymphocyte Cytometric Pattern Is More Accurate than Subepithelial Deposits of Anti-Tissue Transglutaminase IgA for the Diagnosis of Celiac Disease in Lymphocytic Enteritis

Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case-control study

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