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. 2010 Jul;139(1):112-9.
doi: 10.1053/j.gastro.2010.04.007. Epub 2010 Apr 13.

Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study

Marjorie M Walker  1 , Joseph A Murray, Jukka Ronkainen, Pertti Aro, Tom Storskrubb, Mauro D'Amato, Brian Lahr, Nicholas J Talley, Lars Agreus
Affiliations

Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study

Marjorie M Walker et al. Gastroenterology. 2010 Jul.

Abstract

Background & aims: Although serologic analysis is used in diagnosis of celiac disease, histopathology is considered most reliable. We performed a prospective study to determine the clinical, pathologic, and serologic spectrum of celiac disease in a general population (Kalixanda study).

Methods: A random sample of an adult general population (n = 1000) was analyzed by upper endoscopy, duodenal biopsy, and serologic analysis of tissue transglutaminase (tTg) levels; endomysial antibody (EMA) levels were analyzed in samples that were tTg+. The cut off values for diagnosis of celiac disease were villous atrophy with 40 intraepithelial lymphocytes (IELs)/100 enterocytes (ECs).

Results: Samples from 33 subjects were tTg+, and 16 were EMA+. Histologic analysis identified 7 of 1000 subjects (0.7%) with celiac disease; all were tTg+, and 6 of 7 were EMA+. Another 26 subjects were tTg+ (7/26 EMA+). This was addressed by a second quantitative pathology study (nested case control design) using a threshold of 25 IELS/100 ECs. In this analysis, all 13 samples that were tTg+ and EMA+ had > or =25 IELs/100 ECs. In total, 16 subjects (1.6%) had serologic and histologic evidence of gluten-sensitive enteropathy. IELs were quantified in duodenal biopsy samples from seronegative individuals (n = 500); 19 (3.8%) had >25 IELs and lymphocytic duodenosis.

Conclusions: Measurement of > or =25 IELs/100 ECs correlated with serologic indicators of celiac disease; a higher IEL threshold could miss 50% of cases. Quantification of tTg is a sensitive test for celiac disease; diagnosis can be confirmed by observation of > or =25 IELs/100ECs in duodenal biopsy specimens. Lymphocytic enteropathy (celiac disease and lymphocytic duodenosis) is common in the population (5.4%).

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Figures

Figure 1
Figure 1
Select 4 villi with epithelial nuclei aligned to basement membrane (marked 1 – 4). To count IELs, from villus 1: count and record IELs/10 enterocytes, starting at base of crypt (arrow, lowest point between two adjacent villi) continue till next base (dashed arrow), continue counts in of villi marked 2 – 4
Figure 2
Figure 2
Extrapolation of IEL counts/ 10 enterocytes in 4 villi, the graph levels out at 50 enterocytes.
Figure 3
Figure 3
Comparison of D1 and D2 IEL counts in all subjects
Figure 4
Figure 4
Comparison of serology, villous architecture and intraepithelial lymphocyte (IELs) counts/ 100 enterocytes of >40 versus <25/ 100 enterocytes in 16 subjects with diagnosed celiac disease. Sero+ve = positive serology for tTg and EMA, Atrophy = atrophy of villi, (total, B1 or partial, B2)
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References

    1. Dube C, Rostom A, Sy R, Cranney A, Saloojee N, Garritty C, Sampson M, Zhang L, Yazdi F, Mamaladze V, Pan I, Macneil J, Mack D, Patel D, Moher D. The prevalence of celiac disease in average-risk and at-risk Western European populations: a systematic review. Gastroenterology. 2005;128:S57–S67. - PubMed
    1. Murray JA, Van Dyke C, Plevak MF, Dierkhising RA, Zinsmeister AR, Melton LJ., 3rd Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clinical Gastroenterol Hepatol. 2003;1:19–27. - PubMed
    1. Talley NJ, Valdovinos M, Petterson TM, Carpenter HA, Melton LJ., 3rd Epidemiology of celiac sprue: a community-based study. Am J Gastroenterol. 1994;89:843–846. - PubMed
    1. Rossi TM, Albini CH, Kumar V. Incidence of celiac disease identified by the presence of serum endomysial antibodies in children with chronic diarrhea, short stature, or insulin-dependent diabetes mellitus. J Pediatr. 1993;123:262–264. - PubMed
    1. Stenhammar L, Ansved P, Jansson G, Jansson U. The incidence of childhood celiac disease in Sweden. J. Pediatr Gastroenterol Nutr. 1987;6:707–709. - PubMed

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