Intestinal intraepithelial lymphocyte cytometric pattern is more accurate than subepithelial deposits of anti-tissue transglutaminase IgA for the diagnosis of celiac disease in lymphocytic enteritis

PLoS One. 2014 Jul 10;9(7):e101249. doi: 10.1371/journal.pone.0101249. eCollection 2014.

Abstract

Background & aims: An increase in CD3+TCRγδ+ and a decrease in CD3- intraepithelial lymphocytes (IEL) is a characteristic flow cytometric pattern of celiac disease (CD) with atrophy. The aim was to evaluate the usefulness of both CD IEL cytometric pattern and anti-TG2 IgA subepithelial deposit analysis (CD IF pattern) for diagnosing lymphocytic enteritis due to CD.

Methods: Two-hundred and five patients (144 females) who underwent duodenal biopsy for clinical suspicion of CD and positive celiac genetics were prospectively included. Fifty had villous atrophy, 70 lymphocytic enteritis, and 85 normal histology. Eight patients with non-celiac atrophy and 15 with lymphocytic enteritis secondary to Helicobacter pylori acted as control group. Duodenal biopsies were obtained to assess both CD IEL flow cytometric (complete or incomplete) and IF patterns.

Results: Sensitivity of IF, and complete and incomplete cytometric patterns for CD diagnosis in patients with positive serology (Marsh 1+3) was 92%, 85 and 97% respectively, but only the complete cytometric pattern had 100% specificity. Twelve seropositive and 8 seronegative Marsh 1 patients had a CD diagnosis at inclusion or after gluten free-diet, respectively. CD cytometric pattern showed a better diagnostic performance than both IF pattern and serology for CD diagnosis in lymphocytic enteritis at baseline (95% vs 60% vs 60%, p = 0.039).

Conclusions: Analysis of the IEL flow cytometric pattern is a fast, accurate method for identifying CD in the initial diagnostic biopsy of patients presenting with lymphocytic enteritis, even in seronegative patients, and seems to be better than anti-TG2 intestinal deposits.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Celiac Disease / blood
  • Celiac Disease / complications
  • Celiac Disease / diagnosis*
  • Celiac Disease / pathology*
  • Child
  • Child, Preschool
  • Enteritis / complications*
  • Female
  • Flow Cytometry
  • GTP-Binding Proteins / immunology*
  • Humans
  • Immunoglobulin A / blood
  • Immunoglobulin A / immunology*
  • Infant
  • Intestinal Mucosa / immunology*
  • Lymphocytes / pathology*
  • Male
  • Middle Aged
  • Prospective Studies
  • Protein Glutamine gamma Glutamyltransferase 2
  • Sensitivity and Specificity
  • Serologic Tests
  • Transglutaminases / immunology*
  • Young Adult

Substances

  • Immunoglobulin A
  • Protein Glutamine gamma Glutamyltransferase 2
  • Transglutaminases
  • GTP-Binding Proteins

Grants and funding

The study was sponsored by a grant from the Instituto de Salud Carlos III (PI10/00892, Ministry of Health, Spain). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.