A prospective study of the aetiology of lymphocytic duodenosis

Imran Aziz (1) , Kate E Evans (2) , Andrew D Hopper (2) , David M Smillie (3) , David S Sanders (2)

1 Gastroenterology
2 Gastroenterology
3 Histocompatability & Immunogenetics

Background:Lymphocytic duodenosis (LD) is defined by normal villous architecture and intraepithelial lymphocytes (IELs) >25 per 100 enterocytes. Such patients should not be diagnosed with coeliac disease,solely by histology, as previous retrospective studies have suggested other associations with LD. Aim:A prospective study of the aetiology of LD. Method:One hundred patients with LD were rigorously investigated for coeliac disease and other known associations for LD by initial investigations of coeliac serology, and exclusion of infection. Of 34 with no explanation for LD,29 underwent repeat duodenal biopsies following a gluten challenge. Results:Coeliac disease was present in 16% of patients with LD. In the absence of a positive coeliac diagnosis, LD was most commonly associated with drugs(21%), infection(19%), immune dysregulation(4%), inflammatory bowel disease(2%), microscopic colitis(2%), sarcoidosis(1%) and IgA deficiency(1%). Of 34 with no known associations, 18/34 had symptoms of irritable bowel syndrome (IBS) and in 29/34 patients investigated with repeat duodenal biopsies the IEL count returned to normal in 22. Conclusions:In 66% of cases of LD, a known association can be found by further investigations; importantly 16% will have coeliac disease. In those with no apparent cause,there may be an association with IBS and the IEL count became normal on repeat biopsy in 76%.

Mots clés: Medicine

Imran Aziz, Kate E Evans, Andrew D Hopper, David M Smillie, David S Sanders. A prospective study of the aetiology of lymphocytic duodenosis. Alimentary Pharmacology and Therapeutics, 2010, 32 (11-12), pp.1392. ⟨10.1111/j.1365-2036.2010.04477.x⟩. ⟨hal-00582716⟩