Is a raised intraepithelial lymphocyte count with normal duodenal villous architecture clinically relevant?

作者：Sanjiv Mahadeva, J I Wyatt, P D Howdle · 发表于：Journal of Clinical Pathology · 年份：2002 · DOI：10.1136/jcp.55.6.424 · 被引用次数：161 · 研究领域：Celiac Disease Research and Management、Microscopic Colitis、Gastrointestinal motility and disorders

BACKGROUND: A raised intraepithelial lymphocyte (IEL) count with normal villous architecture is a recognised finding in latent coeliac disease. Little information is available in cases without gluten sensitive enteropathy in adults. AIMS: To assess the frequency of such a finding in routine practice and to determine whether it is clinically relevant. METHODS: Patients with subjectively increased IELs as the only abnormality were identified prospectively from a routine duodenal biopsy series over a 12 month period. The biopsy specimens in these index cases were re-examined together with two controls with normal histology for each case, and three counts of IEL/100 epithelial cells were made in all samples. The index cases were then contacted and interviewed to obtain clinical information, approximately 12 months from the initial biopsy. Further data were obtained from their clinical records. RESULTS: Fourteen of 626 (2.2%) patients who had duodenal biopsies over the 12 month period had a subjective increase in IELs with normal villous architecture. Fifteen patients with newly diagnosed gluten sensitive enteropathy were also identified during the study period. Formal counting of the index cases and controls revealed a significant difference in IELs/100 epithelial cell counts between the two (mean, 38 (SD, 6.2) v 12.4 (4.6); p < 0.0001). Three of the 14 index cases tested had a positive coeliac antibody test compared with 12 of 15 newly diagnosed patients with coeliac disease and...