What's the Best Way to Diagnose Celiac Disease in Lymphocytic Enteritis Patients?

Celiac.com 09/08/2014 - Currently, physicians trying to diagnose celiac disease in patients with lymphocytic enteritis look for subepithelial deposits of anti-tissue transglutaminase IgA. However, it is known that an increase in CD3+TCRγδ+ coupled with a decrease in CD3- intraepithelial lymphocytes (IEL) is a flow cytometric pattern clearly indicating celiac disease with atrophy.

To determine which method yielded better diagnostic results, a research team set out to compare and contrast intestinal intraepithelial lymphocyte cytometric pattern with subepithelial deposits of anti-tissue transglutaminase IgA for diagnosing lymphocytic enteritis due to celiac disease.

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The researchers included F. Fernández-Bañares, A. Carrasco, R. García-Puig, M. Rosinach, C. González, M. Alsina, C. Loras, A. Salas, J.M. Viver, M. Esteve.

They are variously affiliated with the Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), the Department of Pediatrics, Hospital Universitari Mutua Terrassa, University of Barcelona, the Department of Pathology, Hospital Universitari Mutua Terrassa, University of Barcelona, CIBERehd, Terrassa, and the Department of Immunology, CATLAB, Viladecavalls, all in Barcelona, Spain.

For their study, the team evaluated 144 women and 61 men, with positive celiac genetics, who underwent duodenal biopsy for celiac disease. Fifty patients showed villous atrophy, and 70 showed lymphocytic enteritis, while 85 showed normal histology. Eight patients with non-celiac atrophy and 15 with lymphocytic enteritis secondary to Helicobacter pylori served as control group.

The team used duodenal biopsies to assess both celiac disease, IEL flow cytometric (complete or incomplete), and IF patterns. Sensitivity of IF, and complete and incomplete cytometric patterns for celiac disease diagnosis in patients with positive serology (Marsh 1+3) was 92%, 85% and 97% respectively, but only the complete cytometric pattern showed 100% specificity.

Twelve seropositive and 8 seronegative Marsh 1 patients received a celiac disease diagnosis at the beginning of the study or after gluten free-diet, respectively.

For celiac disease diagnosis in lymphocytic enteritis at baseline, cytometric pattern yielded better diagnostic results than both IF pattern and serology (95% vs 60% vs 60%, p = 0.039).

Analysis of the IEL flow cytometric pattern offers fast, accurate reliable way to spot celiac disease in the initial diagnostic biopsy of patients presenting with lymphocytic enteritis, even for patients with negative blood screens, and seems superior to anti-TG2 intestinal deposits.

These results support the analysis of the IEL flow cytometric pattern as the best way to spot celiac disease at the first diagnostic biopsy of patients presenting with lymphocytic enteritis, even for patients with negative blood screens.

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