title: Lymphonodular hyperplasia of the terminal ileum associated with colitis shows an increase gammadelta+ t-cell density in children.
abstract: OBJECTIVE
  Recently we reported a close association between lymphonodular hyperplasia (LNH) of the bulb of the duodenum and increased densities of intraepithelial gammadelta+ T-cells in subjects with untreated food allergies. In this study we sought to determine whether children with LNH of the terminal ileum (TI) show a similar correlation.
  
  
  METHODS
  The mucosal specimens taken by colonoscopy from the TIs of 22 children with LNH of the TI without colitis, 13 with right-sided colitis or pancolitis, nine with left-sided colitis, eight with Crohn's disease, and three endoscopically healthy subjects were studied for T-cell subsets with monoclonal antibodies using a three-layer peroxidase staining method.
  
  
  RESULTS
  LNH of the TI was found in 32 of the 55 subjects (58%). In 22 it was the only endoscopic finding, but in nine of 13 subjects (69%) it was related to right-sided colitis or pancolitis. In patients with left-sided colitis or Crohn's disease it was diagnosed only rarely. In the whole study population, LNH of the of the TI showed a significant association with the increment in the density of gammadelta+ T-cells. The subjects with LNH of the TI and colitis starting from the cecum showed the highest values, discriminating them statistically from any other study group. Accordingly their gammadelta+/CD3+ ratio was high. Even in the subjects with LNH of the TI without colitis, the increment in gammadelta+ T-cells was significant as compared with the subjects with left-sided colitis. Upregulations of D-related expression on the mucosa of the TI were similar regardless of the presence of LNH or colitis or an increment in gammadelta+ T-cells.
  
  
  CONCLUSIONS
  Our preliminary observations showed increased densities of intraepithelial gammadelta+ T-cells and elevated gammadelta+/CD3+ ratios in subjects with LNH on the mucosa of the TI, especially if related to colitis starting at the cecem, but not in subjects with typical left-sided colitis or granulomatous Crohn's disease. The study also provides further evidence suggesting the significance of food-borne antigens in the pathogenetic mechanism of right-sided colitis or pancolitis. The finding also indicates the significance of classifying colitis into gammadelta-positive and -negative diseases, and has implications for the treatment of these entities.
authors.affiliation: Department of Pediatrics, University of Oulu, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Kokkonen
authors.forename: Tarja
authors.initials: T
authors.lastname: Ruuska
authors.forename: Tuomo J
authors.initials: TJ
authors.lastname: Karttunen
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
mesh_terms: D000293:Adolescent; D017252:CD3 Complex / Q000097:blood; D005871:Castleman Disease / Q000097:blood / Q000150:complications* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003092:Colitis / Q000097:blood / Q000150:complications* / Q000473:pathology*; D003113:Colonoscopy; D003424:Crohn Disease / Q000097:blood / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000097:blood / Q000150:complications* / Q000473:pathology*; D007082:Ileum / Q000473:pathology*; D018655:Lymphocyte Count; D008297:Male; D013601:T-Lymphocytes / Q000473:pathology*
chemical_list: D017252:CD3 Complex