Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct;5(6):819-826.
doi: 10.1177/2050640616682181. Epub 2016 Nov 24.

Flow cytometry of duodenal intraepithelial lymphocytes improves diagnosis of celiac disease in difficult cases

Affiliations

Flow cytometry of duodenal intraepithelial lymphocytes improves diagnosis of celiac disease in difficult cases

Julio Valle et al. United European Gastroenterol J. 2017 Oct.

Abstract

Background: Diagnosis of celiac disease is difficult when the combined results of serology and histology are inconclusive. Studies using flow cytometry of intraepithelial lymphocytes (IELs) have found that celiac patients have increased numbers of γδ IELs, along with a decrease in CD3-CD103 + IELs.

Objective: The objective of this article is to assess the role of flow cytometric analysis of IELs in the diagnosis of celiac disease in difficult cases.

Methods: A total of 312 patients with suspicion of celiac disease were included in the study. Duodenal biopsy samples were used for histological assessment and for flow cytometric analysis of IELs.

Results: In 46 out of 312 cases (14.7%) the combination of serology and histology did not allow the confirmation or exclusion of celiac disease. HLA typing had been performed in 42 of these difficult cases. Taking into account HLA typing and the response to a gluten-free diet, celiac disease was excluded in 30 of these cases and confirmed in the remaining 12. Flow cytometric analysis of IELs allowed a correct diagnosis in 39 out of 42 difficult cases (92.8%) and had a sensitivity of 91.7% (95% CI: 61.5% to 99.8%) and a specificity of 93.3% (95% CI: 77.9% to 99.2%) for the diagnosis of celiac disease in this setting.

Conclusion: Flow cytometric analysis of IELs is useful for the diagnosis of celiac disease in difficult cases.

Keywords: Celiac disease; flow cytometry; intraepithelial duodenal lymphocytes.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Diagnostic work-up of difficult cases and final diagnosis in 312 patients included in the study. Four cases from the group of difficult cases were excluded because human leukocyte antigen (HLA) typing was not available, leaving a total of 308 patients (191 adult and 117 pediatric patients) for the final analysis.
Figure 2.
Figure 2.
Relative percentage of TcR-γ/δ intraepithelial lymphocytes (IELs) (Panel (a)) and CD3– CD103+ IELs (Panel (b)) with respect to total IELs distributed according to the final diagnosis. Box plots with medians, 25th and 75th percentile and the complete range of IELs.

Similar articles

Cited by

References

    1. Rostom A, Murray JA, Kagnoff MF. American Gastroenterological Association (AGA) Institute technical review on the diagnosis and management of celiac disease. Gastroenterology 2006; 131: 1981–2002. - PubMed
    1. Rubio-Tapia A, Hill ID, Kelly CP, et al. ACG guidelines: Diagnosis and management of celiac disease. Am J Gastroenterol 2013; 108: 656–676. - PMC - PubMed
    1. Ludvigsson JF, Bai JC, Biagi F, et al. Diagnosis and management of adult coeliac disease: Guidelines from the British Society of Gastroenterology. Gut 2014; 63: 1210–1228. - PMC - PubMed
    1. Husby S, Koletzco S, Korponay-Szabó IR, et al. European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines for the diagnosis of celiac disease. J Pediatr Gastroenterol Nutr 2012; 54: 136–160. - PubMed
    1. Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992; 102: 330–354. - PubMed