Abstract
Background & AimsAn increase in CD3+TCRγδ+ and a decrease in CD3− intraepithelial lymphocytes (IEL) is a characteristic flow cytometric pattern of celiac disease (CD) with atrophy. The aim was to evaluate the usefulness of both CD IEL cytometric pattern and anti-TG2 IgA subepithelial deposit analysis (CD IF pattern) for diagnosing lymphocytic enteritis due to CD.MethodsTwo-hundred and five patients (144 females) who underwent duodenal biopsy for clinical suspicion of CD and positive celiac genetics were prospectively included. Fifty had villous atrophy, 70 lymphocytic enteritis, and 85 normal histology. Eight patients with non-celiac atrophy and 15 with lymphocytic enteritis secondary to Helicobacter pylori acted as control group. Duodenal biopsies were obtained to assess both CD IEL flow cytometric (complete or incomplete) and IF patterns.ResultsSensitivity of IF, and complete and incomplete cytometric patterns for CD diagnosis in patients with positive serology (Marsh 1+3) was 92%, 85 and 97% respectively, but only the complete cytometric pattern had 100% specificity. Twelve seropositive and 8 seronegative Marsh 1 patients had a CD diagnosis at inclusion or after gluten free-diet, respectively. CD cytometric pattern showed a better diagnostic performance than both IF pattern and serology for CD diagnosis in lymphocytic enteritis at baseline (95% vs 60% vs 60%, p = 0.039).ConclusionsAnalysis of the IEL flow cytometric pattern is a fast, accurate method for identifying CD in the initial diagnostic biopsy of patients presenting with lymphocytic enteritis, even in seronegative patients, and seems to be better than anti-TG2 intestinal deposits.
Highlights
Seventy patients showed architecturally normal small intestinal mucosa with an increase in intraepithelial lymphocytes (IEL) counts: in 12 of them celiac disease (CD) was suspected because of positive celiac serology, in 15 it was secondary to Helicobacter pylori infection, and in 43 the etiology of lymphocytic enteritis was unknown at inclusion
The CD IEL cytometric patterns using the cut-offs described above are shown in Figure 1
We found that the highest sensitivity for CD diagnosis was achieved by the presence of an incomplete IEL cytometric pattern (97%), whereas both the complete CD IEL cytometric pattern and the combined incomplete/IF pattern had 100% specificity
Summary
Assessment of the density of cd IEL is in general performed with immunohistochemistry techniques in frozen biopsy samples.[2,9,10] Flow cytometry is a powerful analytical tool for the study of small intestinal immune cells and in particular the IEL, and it has been shown to be of value in the diagnosis of CD with atrophy, [11,12,13] and refractory CD.[14,15] The advantages of flow cytometry are considerable compared to other user-dependent techniques, and results are obtained in a fast, sensitive, reproducible and objective semi-quantitative way just a few hours after taking the biopsy sample It allows the analysis of a greater number of cells than does immunohistochemistry and yields a computerized record of the results. The aim was to evaluate the usefulness of both CD IEL cytometric pattern and anti-TG2 IgA subepithelial deposit analysis (CD IF pattern) for diagnosing lymphocytic enteritis due to CD
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
