title: Intraepithelial lymphocytes, scores, mimickers and challenges in diagnosing gluten-sensitive enteropathy (celiac disease).
abstract: The upper digestive tract is routinely scoped for several causes of malabsorption, and the number of duodenal biopsy specimens has increased notably in the last 10 years. Gluten-sensitive enteropathy (GSE) is an autoimmune disease, which shows an increasing prevalence worldwide and requires a joint clinico-pathological approach. The classical histopathology of GSE with partial or total villous blunting is well recognized, but the classification of GSE is not straightforward. Moreover, several mimickers of GSE with intraepithelial lymphocytosis have been identified in the last 20 years, with drug interactions and medical comorbidities adding to the conundrum. In this review, we report on the normal duodenal mucosa, the clinical presentation and laboratory diagnosis of GSE, the duodenal intraepithelial lymphocytes and immunophenotype of GSE-associated lymphocytes, the GSE mimickers, the differences "across oceans" among guidelines in diagnosing GSE, and the use of a synoptic report for reporting duodenal biopsies in both children and adults in the 21stcentury.
authors.affiliation: Consolato Sergi, TianYou Hospital, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China.
authors.forename: Consolato
authors.initials: C
authors.lastname: Sergi
authors.affiliation: Consolato Sergi, TianYou Hospital, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Shen
authors.affiliation: Consolato Sergi, TianYou Hospital, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China.
authors.forename: Gerd
authors.initials: G
authors.lastname: Bouma
mesh_terms: D000465:Algorithms; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000378:metabolism; D003951:Diagnostic Errors; D004386:Duodenum / Q000473:pathology*; D005502:Food; D005762:Gastroenterology / Q000379:methods; D006801:Humans; D016130:Immunophenotyping; D007413:Intestinal Mucosa / Q000473:pathology; D008214:Lymphocytes / Q000378:metabolism*; D012306:Risk
keywords: Duodenum; Gluten; Lymphocytes