title: Usefulness of the organ culture system when villous height/crypt depth ratio, intraepithelial lymphocyte count, or serum antibody tests are not diagnostic for celiac disease.
abstract: The existence of mild forms of celiac disease (CD) can make the histology-based diagnosis difficult to reach. Since anti-endomysium (EMA) and anti-tissue transglutaminase (anti-tTG) are detectable in culture supernatants of duodenal biopsies from CD patients, our aim was to assess if this system can support the histology in the diagnostic work-up. A total of 559 suspected CD patients underwent serum EMA/anti-tTG detection, upper endoscopy with duodenal biopsy sampling, histologic analysis, and organ culture to detect EMA/anti-tTG in supernatants. A subgroup of 30 patients with organ culture positive results were put on a gluten-free diet (GFD). Their gluten-dependency was evaluated by the psychological general well-being and beck depression inventory indexes. Statistical analysis was performed by Cohen k inter-test, Friedman test, and Dunn multiple comparison. Two hundred forty-one out of 559 (43.1%) patients showed intestinal villous atrophy, whereas serum and organ culture EMA/anti-tTG were positive in 293/559 (52.4%) and 334/559 (59.7%) patients, respectively. The strength of agreement resulted good for serology vs histology (k = 0.730), good for organ culture vs histology (k = 0.662), and very good for serology vs organ culture (k = 0.852). After 12 months of GFD, psychological general well-being index significantly increased, and beck depression inventory index significantly decreased (P < 0.001 for each one). Data highlight the organ culture system as a useful tool to assist the histology in diagnosing CD, mainly in cases without villous atrophy or in seronegative patients. The marked improvement in quality of life after a GFD further supports the reliability of this system in diagnosing CD.
authors.affiliation: Department of Internal Medicine and Medical Specialties, Sapienza University, 00161 Rome, Italy. antonio.picarelli@uniroma1.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Picarelli
authors.forename: Marco
authors.initials: M
authors.lastname: Di Tola
authors.forename: Mariacatia
authors.initials: M
authors.lastname: Marino
authors.forename: Valerio
authors.initials: V
authors.lastname: Libanori
authors.forename: Raffaele
authors.initials: R
authors.lastname: Borghini
authors.forename: Elisa
authors.initials: E
authors.lastname: Salvi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Donato
authors.forename: Domenico
authors.initials: D
authors.lastname: Vitolo
authors.forename: Antonio
authors.initials: A
authors.lastname: Tiberti
authors.forename: Adriana
authors.initials: A
authors.lastname: Marcheggiano
authors.forename: Gabrio
authors.initials: G
authors.lastname: Bassotti
authors.forename: Enrico
authors.initials: E
authors.lastname: Corazziari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood / Q000378:metabolism; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000276:immunology / Q000473:pathology; D002648:Child; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000276:immunology / Q000473:pathology; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009924:Organ Culture Techniques / Q000379:methods; D011237:Predictive Value of Tests; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011788:Quality of Life; D011503:Transglutaminases / Q000276:immunology; D057170:Translational Research, Biomedical; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins