Gluten-sensitive disease with mild enteropathy.
OBJECTIVE
Celiac disease is a permanent gluten intolerance strongly associated with HLA class II antigens and possibly showing milder changes of mucosal architecture. Ten patients with symptoms suggesting celiac disease and serum antiendomysium antibodies with normal mucosal architecture were studied.


METHODS
Immunohistochemical detection of mucosal immune activation and HLA typings were performed.


RESULTS
Mucosal immune activation, with normal mucosal architecture and normal gamma/delta+ intraepithelial lymphocytes counts, was found on a gluten-containing diet. In 3 of 6 patients, multiple biopsy specimens showed one sample with severe villous atrophy. Clinical and immunomorphologic features were strictly gluten dependent. The mucosal immune activation was elicited in vitro by gliadin. Only 4 patients had the typical HLA typing of celiac disease.


CONCLUSIONS
Gluten-sensitive celiac-like symptoms may occur in patients with serum antiendomysium antibodies, apparently normal intestinal mucosa, and HLA typing not commonly associated with celiac disease. These patients should undergo multiple biopsies, and signs of immunologic activation should be sought accurately; in the presence of mucosal immune activation, a trial with a gluten-free diet should be encouraged to detect gluten dependency. In vitro immunologic response of small intestinal mucosa to gliadin may support the diagnosis of gluten-sensitive enteropathy.
Picarelli
A
A
Cattedra di Gastroenterologia I, University La Sapienza, Rome, Italy.
Maiuri
L
L
Mazzilli
M C
MC
Coletta
S
S
Ferrante
P
P
Di Giovambattista
F
F
Greco
M
M
Torsoli
A
A
Auricchio
S
S
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis / Q000097:blood; D002446:Celiac Disease / Q000235:genetics / Q000276:immunology* / Q000473:pathology*; D005260:Female; D005819:Genetic Markers; D005903:Gliadin / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000276:immunology; D010446:Peptide Fragments / Q000276:immunology
D000906:Antibodies; D005819:Genetic Markers; D010446:Peptide Fragments; D005903:Gliadin