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. 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

Julio Valle  1 , José Mario T Morgado  2 , Juan Ruiz-Martín  3 , Antonio Guardiola  1 , Miriam Lopes-Nogueras  1 , Almudena García-Vela  1 , Beatriz Martín-Sacristán  4 , Laura Sánchez-Muñoz  2
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.

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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.
See this image and copyright information in PMC

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