title: Villous tip intraepithelial lymphocytes as markers of early-stage coeliac disease.
abstract: BACKGROUND
  An investigation was conducted to determine whether the density of small-intestinal villous tip intraepithelial lymphocytes would be of value in clinical practice in uncovering early-stage coeliac disease.
  
  
  METHODS
  Villous tip, CD3+ and gammadelta+ intraepithelial lymphocytes were counted in patients with definite early-stage coeliac disease without villous atrophy, in classic coeliac disease with manifest mucosal lesion and in non-coeliac controls with normal mucosal structure. Villous tip analysis was made of haematoxylin-eosin specimens and CD3+ and gammadelta+ of immunohistochemical stainings from frozen samples.
  
  
  RESULTS
  The villous tip intraepithelial lymphocyte count was statistically significantly higher in patients with early-stage coeliac disease than in non-coeliac controls. The sensitivity of this method to detect untreated coeliac disease with normal villous architecture was 0.84; the specificity was 0.88. This method proved superior to CD3+ analysis and was at least as good as gammadelta+ analysis in detecting early-stage coeliac disease. In detecting classic coeliac disease, villous tip analysis also reached a higher sensitivity than CD3+ and gammadelta+ cells.
  
  
  CONCLUSIONS
  Villous tip analysis seems to distinguish early coeliac from non-specific changes, thus providing a valuable tool in routine practice, especially when borderline findings are involved. Its value appears to be similar to counting of gammadelta+ cells, which, however, requires frozen biopsy samples.
authors.affiliation: Dept. of Internal Medicine, Tampere University Hospital, Medical School, University of Tampere, Tampere, Finland.
authors.forename: T T
authors.initials: TT
authors.lastname: Järvinen
authors.forename: P
authors.initials: P
authors.lastname: Collin
authors.forename: M
authors.initials: M
authors.lastname: Rasmussen
authors.forename: S
authors.initials: S
authors.lastname: Kyrönpalo
authors.forename: M
authors.initials: M
authors.lastname: Mäki
authors.forename: J
authors.initials: J
authors.lastname: Partanen
authors.forename: T
authors.initials: T
authors.lastname: Reunala
authors.forename: K
authors.initials: K
authors.lastname: Kaukinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000473:pathology*; D015331:Cohort Studies; D004386:Duodenum / Q000473:pathology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D018655:Lymphocyte Count / Q000379:methods*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity