title: Spectrum of gluten-sensitive enteropathy in patients with dysmotility-like dyspepsia.
abstract: BACKGROUND
  Dysmotility-like dyspepsia symptoms are frequent in patients with gluten-sensitive enteropathy (GSE). Current data suggest that patients with mild enteropathy may be present with gluten-sensitive symptoms and complications.
  
  
  OBJECTIVE
  To investigate the prevalence of GSE, including mild enteropathy, in patients with dysmotility-like dyspepsia symptoms.
  
  
  METHODS
  We retrospectively studied 142 patients who presented dysmotility-like dyspepsia symptoms and normal upper gastrointestinal endoscopy. Endoscopic duodenal biopsies were taken and processed using hematoxylin-eosin staining and CD3 immunophenotyping. In patients with enteropathy (number of intraepithelial lymphocytes greater than 25 per 100 enterocytes) we also performed coeliac serology (anti-tissue transglutaminase IgA) and HLA-DQ2/DQ8 genotyping. A gluten-free diet was offered if one of these markers was positive. The final GSE diagnosis was established based on clinical and histopathological response to the gluten-free diet after 18 months of follow-up.
  
  
  RESULTS
  Fifty-one patients (35.9%) had enteropathy; 4 (2.8%) Marsh type 3b, 24 (16.9%) Marsh type 3a, 3 (2.1%) Marsh type 2, and 20 (14.1%) Marsh type 1. A positive serology result was extremely low (6.7%) in mild enteropathy (Marsh type 1-3a) in contrast with Marsh type 3b patients (50%). Most patients with enteropathy had positive HLA DQ2 or -DQ8 genotyping (84.1%). Out of the 37 patients who started a gluten-free diet, 34 (91.9%) improved their symptoms, and 28 of 32 (87.5%) had a histopathological or serological response. A final GSE diagnosis was established in 28 of the 142 patients (19.7%).
  
  
  CONCLUSIONS
  Gluten-sensitive enteropathy can be a frequent and unsuspected cause of dysmotility-like dyspepsia.
authors.affiliation: Department of Gastroenterology and Hepatology, Hospital San Jorge, Huesca, Spain. ssantolariap@indogastro.org
authors.forename: Santos
authors.initials: S
authors.lastname: Santolaria
authors.forename: Javier
authors.initials: J
authors.lastname: Alcedo
authors.forename: Berta
authors.initials: B
authors.lastname: Cuartero
authors.forename: Irene
authors.initials: I
authors.lastname: Diez
authors.forename: Manuel
authors.initials: M
authors.lastname: Abascal
authors.forename: M Dolores
authors.initials: MD
authors.lastname: García-Prats
authors.forename: Miguel
authors.initials: M
authors.lastname: Marigil
authors.forename: Jesús
authors.initials: J
authors.lastname: Vera
authors.forename: Margarita
authors.initials: M
authors.lastname: Ferrer
authors.forename: Miguel
authors.initials: M
authors.lastname: Montoro
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000150:complications*; D004415:Dyspepsia / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult