Redefining the intraepithelial lymphocytes threshold to diagnose gluten sensitivity in patients with architecturally normal duodenal histology

Salvatore Pellegrino (1) , Vincenzo Villanacci (2) , Naire Sansotta (1) , Rosa Scarfì (3) , Gabrio Bassotti (4) , Giuseppe Vieni (1) , Alessandro Princiotta (5) , Concetta Sferlazzas (1) , Giuseppe Magazzù (1) , Giovanni Tuccari (3)

1 Pediatrics
2 Pathology
3 Human Pathology
4 Clinical & Experimental Medicine
5 Human Pathology

BACKGROUND: accuracy of intraepithelial lymphocytes (IELs) counts for diagnosing mild enteropathy celiac disease (MECD) in absence of villous atrophy can be limited by inappropriate controls included in the studies. AIM: to determine the diagnostic accuracy of IELs counts utilizing controls lacking HLA celiac disease-associated alleles METHODS: IELs counting at villus tip and per 100 enterocytes were performed at Hematoxylin eosin (H&E) and CD3-stainings in: 29 cases (21 with potential celiac disease and 8 affected by latent celiac disease) representing the patient population and 14 non-celiac controls lacking HLA-DQ2/DQ8 alleles. RESULTS: Threshold (mean+2SD) of duodenal IELs at villus tip and per 100 enterocytes in non-celiac controls was respectively: 3.5 and 18 at H&E, 3.2 and 17 following CD3-staining. Considering the whole patient population, the sensitivity of tip IELs in detecting MECD was 89.6%(95%CI=72.6-97.8) both at H&E and CD3-stainings. The sensitivity of IELs per 100 enterocytes was 93.1%(95%CI=77.2-99.2) both at H&E and CD3-staining. Specificity of both IELs counts was 100%(95%CI=76.8-100). Using a threshold of 25 IELs per 100 enterocytes could miss 59% of cases at H&E and 48% following CD3-staining. CONCLUSIONS: IELs counts are diagnostic feasible tools to detect MEDC. Threshold of duodenal IELs may be lower than currently accepted.

Mots clés: Medicine

Salvatore Pellegrino, Vincenzo Villanacci, Naire Sansotta, Rosa Scarfì, Gabrio Bassotti, et al.. Redefining the intraepithelial lymphocytes threshold to diagnose gluten sensitivity in patients with architecturally normal duodenal histology. Alimentary Pharmacology and Therapeutics, 2011, 33 (6), pp.697. ⟨10.1111/j.1365-2036.2011.04578.x⟩. ⟨hal-00610681⟩