Intraepithelial lymphocytes in celiac disease.
OBJECTIVE
The aim of this study was to investigate the value of immunohistochemical characterization of different intraepithelial lymphocytes (IELs) in the diagnostic workup of celiac disease (CD).


METHODS
The study involved 928 consecutive adult patients undergoing endoscopy undertaken on suspicion of CD or to ascertain the dietary compliance; the control group consisted of 59 adults who underwent endoscopy because of indigestion. Small bowel mucosal morphology, CD3+, alphabeta+, and gammadelta+ IELs were determined.


RESULTS
CD was detected in 138 and excluded in 545 adults. CD3+ and gammadelta+ IELs both showed a sensitivity of 93% for CD; specificity was 73% and 88%, respectively. For alphabeta+ cells, the sensitivity was 83% and specificity, 66%. The mucosal morphology recovered on a gluten-free diet and the densities of different IELs, even gammadelta+ cells, decreased. Only the density of gammadelta+ cells remained elevated compared with controls.


CONCLUSIONS
Counting of IELs is recommended in borderline cases where the histology is difficult to interpret. An increase especially in gammadelta+ cells strengthens the probability of CD. However, IELs are not invariably increased in CD.
Järvinen
Teea T
TT
Department of Internal Medicine, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland.
Kaukinen
Katri
K
Laurila
Kaija
K
Kyrönpalo
Sinikka
S
Rasmussen
Martin
M
Mäki
Markku
M
Korhonen
Heikki
H
Reunala
Timo
T
Collin
Pekka
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology*; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology*; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D017260:Receptor-CD3 Complex, Antigen, T-Cell
D017260:Receptor-CD3 Complex, Antigen, T-Cell