title: Intestinal intraepithelial lymphocyte cytometric pattern is more accurate than subepithelial deposits of anti-tissue transglutaminase IgA for the diagnosis of celiac disease in lymphocytic enteritis.
abstract: OBJECTIVE
  An increase in CD3+TCRγδ+ and a decrease in CD3- intraepithelial lymphocytes (IEL) is a characteristic flow cytometric pattern of celiac disease (CD) with atrophy. The aim was to evaluate the usefulness of both CD IEL cytometric pattern and anti-TG2 IgA subepithelial deposit analysis (CD IF pattern) for diagnosing lymphocytic enteritis due to CD.
  
  
  METHODS
  Two-hundred and five patients (144 females) who underwent duodenal biopsy for clinical suspicion of CD and positive celiac genetics were prospectively included. Fifty had villous atrophy, 70 lymphocytic enteritis, and 85 normal histology. Eight patients with non-celiac atrophy and 15 with lymphocytic enteritis secondary to Helicobacter pylori acted as control group. Duodenal biopsies were obtained to assess both CD IEL flow cytometric (complete or incomplete) and IF patterns.
  
  
  RESULTS
  Sensitivity of IF, and complete and incomplete cytometric patterns for CD diagnosis in patients with positive serology (Marsh 1+3) was 92%, 85 and 97% respectively, but only the complete cytometric pattern had 100% specificity. Twelve seropositive and 8 seronegative Marsh 1 patients had a CD diagnosis at inclusion or after gluten free-diet, respectively. CD cytometric pattern showed a better diagnostic performance than both IF pattern and serology for CD diagnosis in lymphocytic enteritis at baseline (95% vs 60% vs 60%, p = 0.039).
  
  
  CONCLUSIONS
  Analysis of the IEL flow cytometric pattern is a fast, accurate method for identifying CD in the initial diagnostic biopsy of patients presenting with lymphocytic enteritis, even in seronegative patients, and seems to be better than anti-TG2 intestinal deposits.
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa (Barcelona), Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernández-Bañares
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa (Barcelona), Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Carrasco
authors.affiliation: Department of Pediatrics, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa (Barcelona), Spain.
authors.forename: Roger
authors.initials: R
authors.lastname: García-Puig
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa (Barcelona), Spain.
authors.forename: Mercè
authors.initials: M
authors.lastname: Rosinach
authors.affiliation: Department of Pathology, Hospital Universitari Mutua Terrassa, University of Barcelona, CIBERehd, Terrassa (Barcelona), Spain.
authors.forename: Clarisa
authors.initials: C
authors.lastname: González
authors.affiliation: Department of Immunology, CATLAB, Viladecavalls (Barcelona), Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Alsina
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa (Barcelona), Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Loras
authors.affiliation: Department of Pathology, Hospital Universitari Mutua Terrassa, University of Barcelona, CIBERehd, Terrassa (Barcelona), Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salas
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa (Barcelona), Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Viver
authors.affiliation: Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa (Barcelona), Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Esteve
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004751:Enteritis / Q000150:complications*; D005260:Female; D005434:Flow Cytometry; D019204:GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood / Q000276:immunology*; D007223:Infant; D007413:Intestinal Mucosa / Q000276:immunology*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D011503:Transglutaminases / Q000276:immunology*; D055815:Young Adult
chemical_list: D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins