title: Normal villous architecture with increased intraepithelial lymphocytes: a duodenal manifestation of Crohn disease.
abstract: OBJECTIVE
  To assess a possible association between inflammatory bowel disease (IBD) and the histologic finding in duodenal biopsy specimens of increased intraepithelial lymphocytes (IELs) with normal villous architecture.
  
  
  METHODS
  We identified all patients with duodenal biopsy specimens obtained between 2000 and 2010 showing increased IELs and normal architecture. Among the 74 such patients who also had IBD, we characterized the clinical features of IBD and reviewed all available upper gastrointestinal biopsy specimens.
  
  
  RESULTS
  Fifty-eight patients had Crohn disease, 13 had ulcerative colitis, and three had IBD, type unclassified. No duodenal sample with increased IELs had other histologic features of IBD. Among gastric biopsy specimens from 34 patients with Crohn disease, nearly half (16) had focal gastritis.
  
  
  CONCLUSIONS
  We propose that Crohn disease be included in the differential diagnosis for increased IELs with normal villous architecture in duodenal biopsy specimens, particularly when gastric biopsy specimens show focal gastritis.
authors.affiliation: From the Division of Anatomic Pathology.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Patterson
authors.affiliation: Department of Internal Medicine.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Shmidt
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, and.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Oxentenko
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Felicity T
authors.initials: FT
authors.lastname: Enders
authors.affiliation: From the Division of Anatomic Pathology, Smyrk.Thomas@mayo.edu.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000276:immunology / Q000473:pathology; D002648:Child; D003093:Colitis, Ulcerative / Q000473:pathology; D003424:Crohn Disease / Q000276:immunology / Q000473:pathology*; D003937:Diagnosis, Differential; D004386:Duodenum / Q000276:immunology / Q000473:pathology*; D004502:Education, Medical, Continuing; D005260:Female; D005756:Gastritis / Q000276:immunology / Q000473:pathology*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000276:immunology / Q000473:pathology*; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology; D008218:Lymphocytosis / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Crohn disease; Duodenal intraepithelial lymphocytes; Etiology