Abstract
Introduction: The study of intraepithelial lymphocytes (IEL) by flow cytometry is a useful tool in the diagnosis of coeliac disease (CD). Previous data showed that an increase in %TCRγδ+ and decrease of %CD3− IEL constitute a typical CD cytometric pattern with a specificity of 100%. However, there are no data regarding whether there are differences in the %TCRγδ+ related to sex, age, titers of serology, and degree of histological lesion. Study aims: To confirm the high diagnostic accuracy of the coeliac cytometric patterns. To determine if there are differences between sex, age, serology titers, and histological lesion grade. Results: We selected all patients who fulfilled “4 of 5” rule for CD diagnosis (n = 169). There were no differences in %TCRγδ+ between sexes (p = 0.909), age groups (p = 0.986), serology titers (p = 0.53) and histological lesion grades (p = 0.41). The diagnostic accuracy of complete CD cytometric pattern was: specificity 100%, sensitivity 82%, PPV 100%, NPV 47%. Conclusion: We confirmed, in a validation cohort, the high diagnostic accuracy of complete CD pattern irrespective of sex, age, serology titers, and grade of mucosal lesion.
Highlights
The study of intraepithelial lymphocytes (IEL) by flow cytometry is a useful tool in the diagnosis of coeliac disease (CD)
The study of duodenal intraepithelial lymphocytes (IEL) by flow cytometry is a useful tool for CD diagnosis
We excluded patients with intake of NSAIDs and Olmesartan, and patients with Crohn’s disease, autoimmune diseaseassociated enteropathy, collagenous sprue associated with collagenous colitis, lymphocytic enteritis due to intestinal parasitosis or Helicobacter pylori, and selective IgA deficiency
Summary
The study of intraepithelial lymphocytes (IEL) by flow cytometry is a useful tool in the diagnosis of coeliac disease (CD). Conclusion: We confirmed, in a validation cohort, the high diagnostic accuracy of complete CD pattern irrespective of sex, age, serology titers, and grade of mucosal lesion. The diagnosis of coeliac disease (CD) is based on several criteria including positive serology, a spectrum of duodenal damage and clinical symptoms and/or risk conditions, and response to a gluten-free diet (GFD) in patients bearing the HLA-DQ2 or DQ8 genotypes. When some of these criteria are lacking, especially when serology is negative or the duodenal atrophy is not complete, the CD diagnosis is a challenge [1]. The diagnosis of CD in the case of mild histological lesions (Marsh 1) can be difficult due to low sensitivity of serology and low specificity of the lymphocytic enteritis [9,10]
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