A Scoring System for Identifying Patients Likely to Be Diagnosed with Low-Grade Coeliac Enteropathy.

Fernando Fernández-Bañares,Roger García-Puig,Eva Tristán,Clarisa González,Beatriz Arau,Yamile Zabana,Mercè Rosinach,Anna Carrasco,Maria Esteve

doi:10.3390/nu11051050

Fernando Fernández-Bañares, Roger García-Puig + Show 7 more

Open Access

https://doi.org/10.3390/nu11051050

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Abstract

Background & Aims: Determining whether patients with lymphocytic enteritis (LE) have coeliac disease is a challenge. We analysed the variables associated with a low-grade coeliac enteropathy diagnosis in patients with suspected coeliac disease but without villous atrophy, and developed a scoring system to identify them. Methods: We collected data from 2010 through to 2016 on patients with lymphocytic enteritis and persistent symptoms compatible with the clinical spectrum of coeliac disease. One hundred and four patients starting on a gluten-free diet (GFD) were included. Duodenal biopsies were collected before the GFD and analysed for numbers of CD3+ T-cell receptor gamma delta+ (TCRγδ+), and CD3− intraepithelial lymphocytes. We performed a logistic regression analysis to identify factors associated with a low-grade coeliac enteropathy diagnosis. Results: Sixty-two patients achieved clinical remission after the GFD. Fifty of these 62 patients were diagnosed with low-grade coeliac enteropathy. Multivariate analysis identified the presence of >25% intraepithelial lymphocytosis, HLA-DQ2.5, positive serology, and increased numbers of TCRγδ+ cells with a low-grade coeliac enteropathy diagnosis. We developed a scoring system that identified patients with an area under the ROC curve (AUC) of 0.91. Scores of >10 had 86% sensitivity and 85% specificity. Conclusion: We developed a scoring system that identifies patients likely to be diagnosed with low-grade coeliac enteropathy with an AUC value of 0.91.

Highlights

The spectrum of the so-called gluten-related disorders has expanded beyond well-recognised conditions such as coeliac disease (CD) and dermatitis herpetiformis, and encompasses other disorders whose aetiologies have been connected to gluten [1]
The clinical picture of patients before starting the gluten-free diet (GFD) is described in Supplementary Table S1, according to whether they had presented a response to GFD or not
We developed a scoring system that identifies patients likely to be diagnosed with low-grade coeliac enteropathy with an area under the Receiving operator curves (ROC) curve (AUC) value of 0.91

Summary

Introduction

The spectrum of the so-called gluten-related disorders has expanded beyond well-recognised conditions such as coeliac disease (CD) and dermatitis herpetiformis, and encompasses other disorders whose aetiologies have been connected to gluten [1] Chief among these is non-coeliac gluten sensitivity (NCGS), which has been diagnosed in individuals who do not have CD or wheat allergy but whose clinical symptoms are dependent on gluten [1]. Some patients exhibiting an increase in IEL express CD3+ T-cell receptor gamma delta+ (TCRγδ+ ), which are considered to be suggestive of CD [4]. Duodenal biopsies were collected before the GFD and analysed for numbers of CD3+ T-cell receptor gamma delta+ (TCRγδ+ ), and CD3− intraepithelial lymphocytes. We performed a logistic regression analysis to identify factors associated with a low-grade coeliac enteropathy diagnosis

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Results

Conclusion