title: Clinical expression of lymphocytic duodenosis in "mild enteropathy" celiac disease and in functional gastrointestinal syndromes.
abstract: OBJECTIVE
  Abnormally high number of duodenal intraepithelial lymphocytes is frequently found in many conditions including mild enteropathy celiac disease (CD) and functional gastrointestinal syndromes, but is unclear whether lymphocytosis affects the clinical phenotype particularly in functional syndromes.
  
  
  METHODS
  We compared clinical characteristics of celiac patients with lymphocytic duodenosis and normal villous structure with those of patients with functional gastrointestinal syndromes with and without lymphocytic duodenosis. We retrospectively identified 3 cohorts among patients referred for suspected CD: (1) "CoelD", 135 patients (age 36 ± 14 years) with mild enteropathy CD; (2) "LymD", 245 patients (38 ± 12 years) with functional gastrointestinal syndromes and lymphocytic duodenosis; and (3) "NorD", 147 patients (37 ± 15 years) with functional syndromes and normal duodenal histology.
  
  
  RESULTS
  Prevalence of gastrointestinal symptoms was similar in the three cohorts, but prevalence of extra-intestinal manifestations (42% vs. 27% vs. 18%, p < 0.003) and of associated diseases (35% vs. 15% vs. 14%, p < 0.0001) was higher in "CoelD" than in "LymD" and "NorD", respectively. Prevalence of Helicobacter pylori infection was similar in the three cohorts. The proportion of patients with final diagnosis of irritable bowel syndrome-diarrhea (38% vs. 37%), dyspepsia (31% vs. 27%), functional pain (14% vs. 19%), and functional diarrhoea (14% vs. 11%) was virtually the same in the cohorts with (LymD) and without (NorD) lymphocytic duodenosis.
  
  
  CONCLUSIONS
  Lymphocytic duodenosis has different clinical presentation in patients with mild enteropathy CD than those with functional gastrointestinal syndromes, and is not specific for any particular functional syndrome.
authors.affiliation: Gastroenterology Unit, University and Spedali Civili , Brescia , Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zanini
authors.forename: Francesco
authors.initials: F
authors.lastname: Lanzarotto
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.forename: Nice
authors.initials: N
authors.lastname: Carabellese
authors.forename: Chiara
authors.initials: C
authors.lastname: Ricci
authors.forename: Alberto
authors.initials: A
authors.lastname: Lanzini
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis*; D003967:Diarrhea / Q000150:complications / Q000175:diagnosis*; D004378:Duodenal Diseases / Q000209:etiology* / Q000473:pathology; D004415:Dyspepsia / Q000150:complications / Q000175:diagnosis*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis*; D008218:Lymphocytosis / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: celiac disease; clinical presentation; duodenal histology; functional gastrointestinal syndromes; microscopic enteritis; mild enteropathy