Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study.
OBJECTIVE
Although serologic analysis is used in diagnosis of celiac disease, histopathology is considered most reliable. We performed a prospective study to determine the clinical, pathologic, and serologic spectrum of celiac disease in a general population (Kalixanda study).


METHODS
A random sample of an adult general population (n = 1000) was analyzed by upper endoscopy, duodenal biopsy, and serologic analysis of tissue transglutaminase (tTg) levels; endomysial antibody (EMA) levels were analyzed in samples that were tTg+. The cut off values for diagnosis of celiac disease were villous atrophy with 40 intraepithelial lymphocytes (IELs)/100 enterocytes (ECs).


RESULTS
Samples from 33 subjects were tTg+, and 16 were EMA+. Histologic analysis identified 7 of 1000 subjects (0.7%) with celiac disease; all were tTg+, and 6 of 7 were EMA+. Another 26 subjects were tTg+ (7/26 EMA+). This was addressed by a second quantitative pathology study (nested case control design) using a threshold of 25 IELS/100 ECs. In this analysis, all 13 samples that were tTg+ and EMA+ had > or =25 IELs/100 ECs. In total, 16 subjects (1.6%) had serologic and histologic evidence of gluten-sensitive enteropathy. IELs were quantified in duodenal biopsy samples from seronegative individuals (n = 500); 19 (3.8%) had >25 IELs and lymphocytic duodenosis.


CONCLUSIONS
Measurement of > or =25 IELs/100 ECs correlated with serologic indicators of celiac disease; a higher IEL threshold could miss 50% of cases. Quantification of tTg is a sensitive test for celiac disease; diagnosis can be confirmed by observation of > or =25 IELs/100ECs in duodenal biopsy specimens. Lymphocytic enteropathy (celiac disease and lymphocytic duodenosis) is common in the population (5.4%).
Walker
Marjorie M
MM
Department of Histopathology, Faculty of Medicine, St. Mary's Campus, Imperial College London, London, United Kingdom. mm.walker@imperial.ac.uk
Murray
Joseph A
JA
Ronkainen
Jukka
J
Aro
Pertti
P
Storskrubb
Tom
T
D'Amato
Mauro
M
Lahr
Brian
B
Talley
Nicholas J
NJ
Agreus
Lars
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D005260:Female; D006683:HLA-DQ Antigens / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012698:Serologic Tests
D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen
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