Diagnosing Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology

Celiac.com 08/12/2011 - Although serological analysis is used in diagnosing celiac disease, histopathology is regarded as most reliable.

A team of researchers set out to assess the clinical, pathological and serological spectrum of celiac disease in a general population via prospective study (Kalixanda study).

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The research team included Marjorie M. Walker, Joseph A. Murray, Jukka Ronkainen, Pertti Aro, Tom Storskrubb, Mauro D’Amato, Brian Lahr, Nicholas J. Talley, and Lars Agreus.

For their study, the team evaluated a random sample of 1000 adults from the general population by upper endoscopy, duodenal biopsy, and serological analysis of tissue transglutaminase (tTg) levels. They screened samples that were tTg+ for endomysial antibody (EMA) levels.

The baseline value for celiac diagnosis was villous atrophy with 40 intraepithelial lymphocytes (IELs)/100 enterocytes (ECs).

The team found 33 subjects with tTg+ and 16 with EMA+. Their histological analysis showed 7/1000 subjects (0.7%) with celiac disease, all of whom showed tTg+ and 6 of 7 of whom showed EMA+.

Another 26 subjects showed tTg+, 7 of 26 showing EMA+. The team then addressed these cases with a second quantitative pathology study, this one a nested case-control design, that used a celiac diagnosis baseline of 25 IELS/100 ECs. Under this criteria, all 13 samples that were tTg+ and EMA+ had more than 25 IELs/100ECs.

A total of 16 subjects (1.6%) showed serological and histological evidence of gluten-sensitive enteropathy. The team quantified IELs in duodenal biopsy samples from 500 seronegative individuals. A total of 19 (3.8%) of those subjects had >25 IELs and lymphocytic duodenosis (LD).

A celiac diagnosis level of ≥25 IELs/100 ECs was strongly associated with serological indicators of celiac disease, while a higher IEL threshold missed half of cases.

Quantification of tTg is a sensitive test for celiac disease, and diagnosis can be confirmed by observation of ≥25 IELs/100ECs in duodenal biopsy. Lymphocytic enteropathy in the form of both celiac disease and Lymphocytic duodenitis, is common, occurring in about 5.4% of the general population.

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