Serology in adults with celiac disease: limited accuracy in patients with mild histological lesions

Licata, Anna; Cappello, Maria; Arini, Andrea; Florena, Ada Maria; Randazzo, Claudia; Butera, G.; Almasio, Piero Luigi; Craxı̀, Antonio

doi:10.1007/s11739-011-0585-8

Cited by 12 publications

(15 citation statements)

References 36 publications

(40 reference statements)

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“…Moreover, DQ2 is carried by almost a third of the general population. The cases of mild histological lesions described by Licata and colleagues [4] show a lower predominance of HLA-DQ2/DQ8 genotype. Does this finding open a door to a possible different genetic pattern in this subtype of patients that has not yet been studied?…”

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confidence: 80%

“…In this issue of Internal and Emergency Medicine, Licata and colleagues [4] report on a very hot topic, coeliac patients with only minimal intestinal lesions, and how to diagnose them. Other clinicians have investigated this point [5,6].…”

mentioning

confidence: 99%

“…Licata et al [4] remind us that nowadays there is a mare magnum of available diagnostic tools for CD, in which only the clinician can make some order and attribute the real weight to each clue, in the individual clinical case. While the diagnosis of CD seems to have become easier over the years, the facilities are a double-edged weapon: the diagnosis of CD is still challenging.…”

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confidence: 99%

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Histologic evidence for mild lesions in coeliac disease: the challenge is open

Biagi

2011

Intern Emerg Med

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Even though research on coeliac disease (CD) has already given us fundamental clinical and pathogenic clarifications, CD is a very complex disease that has not finished surprising us. In the last two decades, the attention of clinicians was focussed on the wide spectrum of clinical presentations of the disease. This has made it possible to diagnose many patients with minor and silent forms of CD, particularly in adulthood, patients who would not have received a diagnosis in the past [1]. In the meanwhile, the incidence and prevalence of CD in Western Countries have increased so greatly that awareness of CD has increased not only among clinicians, but also among the public and alternative medicine practitioners, often producing a great deal of confusion in the correct criteria for diagnosis [2,3].In this issue of Internal and Emergency Medicine, Licata and colleagues [4] report on a very hot topic, coeliac patients with only minimal intestinal lesions, and how to diagnose them. Other clinicians have investigated this point [5,6]. Among the first, Rostami [5] cast doubts about the great sensitivity of endomysium and gliadin antibodies in the diagnosis of CD in the cases with only mild lesions found on histology. The accuracy of antibody tests for CD was reviewed by Hill and colleagues [7], who found 95% mean sensitivity and 99% mean specificity for IgA endomysial antibodies, and 87 and 95%, respectively, for IgA tissue transglutaminase antibodies. Obviously, all the serology known for CD was developed using villous atrophy as the gold standard reference, and this can be considered a limit. It became clear that there were some subjects with stigmata of CD, who present positive antibodies many years before developing the enteropathy [8], and these patients were called potentials. Moreover, there are reports of relatives of coeliac patients who have only an increased number of intraepithelial lymphocytes with negative antibodies, but who should also be considered potentials. [9].On the other hand, the same question regarding the sensitivity of coeliac antibodies in those CD cases without frank atrophy could be put the other way around: are minimal lesions seen on histology specific for CD? Such a question would make the discussion even more complex. We cannot forget that Marsh himself, while classifying coeliac enteropathy histological findings by degree of severity, argues that none of the findings are specific for CD [10]. Many authors describe many alternative causes of intraepithelial lymphocytosis to CD [11][12][13][14]. Therefore, it is reasonable to argue that intraepithelial lymphocytosis, like inflammation, is a common pathological finding.The absence of genetic predisposition can help to exclude CD in borderline case, and a so-called gene-dose effect of HLA-DQ2 in the severity of intestinal atrophy and in the prognosis of refractory CD has been described. Nevertheless, researchers estimate that the genetic effect attributable to HLA is 53%, agreeing that other non-HLA regions must be involved. Moreover, DQ2...

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Histologic evidence for mild lesions in coeliac disease: the challenge is open

Biagi

2011

Intern Emerg Med

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“…22 However, the situation is different in Marsh type 1 injury pattern, since it is well established that the likelihood of a positive test correlates with the degree of mucosal injury, and GSE cases with intraepithelial lymphocytosis alone can often have antibody titers in the normal range. [23][24][25] Thus, negative serology does not exclude a diagnosis of GSE with a Marsh type 1 pattern (that is, normal architecture with preserved crypt to villi ratio and increased IELs); a morphologic evaluation remains relevant.…”

Section: Gluten-sensitive Enteropathymentioning

confidence: 99%

“…However, its usefulness is limited; a negative result makes a diagnosis of celiac disease very unlikely, but a positive test does not establish a diagnosis, in the context of duodenal lymphocytosis, because the DQ8/DQ2 haplotypes are seen in 25-40% of the general population. 25,26 As other genes are believed to have a role in the development of GSE, many clinicians resort to a trial of gluten-free diet, or sometimes, a gluten challenge followed by rebiopsy.…”

Section: Gluten-sensitive Enteropathymentioning

confidence: 99%

Duodenal lymphocytosis with no or minimal enteropathy: much ado about nothing?

2015

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Coeliac disease: an old or a new disease? History of a pathology

et al. 2014

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The celiac disease is an ancient pathology, present since the introduction of the wheat in the diet, of which the first description of the compatible clinical symptoms and signs goes back to 250 A.D. Today it is known that the expression of this pathology is multifaceted, ranging from clinical features indicative of bowel disease and malabsorption, until symptoms once unexpected, because of their extra-digestive clinical features. With our work, we wanted to retrace the history of this disease, correlating it with the intake of gluten present in wheat after cooking , ever since mankind has increased the cultivation of cereals. Re-evaluating the clinical and instrumental methods for the diagnosis of Celiac Disease, and benefitting from the most modern techniques for the morphological, biochemical and genetic study of the patients, we sought to understand whether the incidence of the disease is actually increased or if has been considered less frequent for the lower valuation of the signs once deemed more atypical, but currently considered preliminary indicative of the pathology, for its association with other autoimmune diseases, and for the study of some genetic and familiar characteristics. Each of these factors has led the modern medicine to increase epidemiological studies and expand the research potential carriers of celiac disease with safer diagnostic tests.

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Serology in adults with celiac disease: limited accuracy in patients with mild histological lesions

Cited by 12 publications

References 36 publications

Histologic evidence for mild lesions in coeliac disease: the challenge is open

Histologic evidence for mild lesions in coeliac disease: the challenge is open

Duodenal lymphocytosis with no or minimal enteropathy: much ado about nothing?

Coeliac disease: an old or a new disease? History of a pathology

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