Small-bowel mucosal inflammation in reticulin or gliadin antibody-positive patients without villous atrophy.
BACKGROUND
We investigated whether individuals with positive coeliac disease antibodies but without small-bowel villous atrophy have mucosal inflammation implicating gluten-sensitivity.


METHODS
Small-bowel mucosal morphology; CD3+, alphabeta+, and gammadelta+ T-cell receptor-bearing intraepithelial lymphocytes; and mucosal HLA-DR expression were studied in 96 IgA-class antireticulin or antigliadin antibody-positive adults suspected of having coeliac disease and in 27 control subjects.


RESULTS
Villous atrophy compatible with coeliac disease was found in altogether 29 patients, in 18 of 21 (86%) patients with both antireticulin and antigliadin antibodies, in 9 of 15 (60%) patients with antireticulin antibodies only, and in 2 of 60 (3%) with antigliadin antibodies only. In 67 antibody-positive patients with normal villous architecture the densities of CD3+, alphabeta+, and gammadelta+ intraepithelial lymphocytes were significantly higher than in non-coeliac control subjects. Ten patients with initially increased densities of gammadelta+ T cells but normal villous structure underwent a follow-up biopsy after 4-18 months, which showed villous atrophy in five patients.


CONCLUSIONS
IgA-class antireticulin or antigliadin antibody-positive patients with normal small-bowel mucosal morphology frequently have immunohistochemical markers of coeliac disease latency. Together with our follow-up data this implies that they may be gluten-sensitive.
Dept. of Medicine and Paediatrics, Tampere University Hospital, Medical School, and Institute of Medical Technology, University of Tampere, Finland.
K
K
Kaukinen
P
P
Collin
K
K
Holm
A L
AL
Karvonen
P
P
Pikkarainen
M
M
Mäki
D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood*; D001284:Atrophy; D017252:CD3 Complex / Q000032:analysis; D002446:Celiac Disease / Q000276:immunology* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005903:Gliadin / Q000276:immunology*; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007413:Intestinal Mucosa / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000032:analysis; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000032:analysis; D012155:Reticulin / Q000276:immunology*
D000906:Antibodies; D017252:CD3 Complex; D006684:HLA-DR Antigens; D007070:Immunoglobulin A; D016693:Receptors, Antigen, T-Cell, alpha-beta; D016692:Receptors, Antigen, T-Cell, gamma-delta; D012155:Reticulin; D005903:Gliadin