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