Humoral response to wheat protein in patients with coeliac disease and enteropathy associated T cell lymphoma.
Features that might distinguish uncomplicated coeliac disease from enteropathy associated T cell lymphoma were investigated. Of 76 patients with coeliac disease, 71 (93%) had raised levels of alpha gliadin antibody and all responded clinically and histologically to treatment with a gluten free diet. In contrast, none of 16 patients with enteropathy associated T cell lymphoma had raised levels of alpha gliadin antibody, and treatment with a gluten free diet resulted in histological improvement in one and transient clinical improvement in six patients. The ratio of women to men was 2.2:1 in the group with coeliac disease and 1:1.6 in the patients with enteropathy associated T cell lymphoma. Thus patients with enteropathy associated T cell lymphoma do not display a humoral immune response to wheat protein (alpha gliadin), rarely respond to a gluten free diet, and are often men. Patients with uncomplicated coeliac disease usually have raised levels of alpha gliadin antibody, always respond to a gluten free diet, and are frequently women. These findings suggest the presence of two separate forms of enteropathy: one is benign and sensitive to wheat protein whereas the other runs a malignant course.
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis; D001284:Atrophy; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000276:immunology / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005903:Gliadin / Q000276:immunology*; D005983:Glutens; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008223:Lymphoma / Q000175:diagnosis* / Q000276:immunology; D008286:Malabsorption Syndromes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010940:Plant Proteins / Q000276:immunology*; D013601:T-Lymphocytes / Q000276:immunology*
D000906:Antibodies; D010940:Plant Proteins; D005983:Glutens; D005903:Gliadin