Nonceliac Gluten Intolerance - Follow Up Care?
Posted 16 January 2013 - 04:35 PM
Stage 0 Preinfiltrative mucosa; up to 30% of patients with dermatitis herpetiformis (DH) or
gluten ataxia have small-intestinal biopsy specimens that appear normal
Stage 1 Increase in the number of intraepithelial lymphocytes (IELs) to more than 30 per
Stage 2 Crypt hyperplasia. In addition to the increased IELs, there is an increase in crypt
depth without a reduction in villus height. Gluten challenge can induce these
changes, which can also be seen in 20% of untreated patients with dermatitis
herpetiformis and celiac disease
Stage 3 Villous atrophy: A, partial; B, subtotal; C, total. This is the classic celiac lesion. It
is found in 40% of DH patients. Despite marked mucosal changes, many
individuals are asymptomatic and therefore classified as having subclinical or
silent cases. This lesion is characteristic of, but not diagnostic of, celiac disease
and can also be seen with severe giardiasis, infantile food sensitivities, graftversus-
host disease, chronic ischemia of the small intestine, tropical sprue,
immunoglobulin deficiencies, and other immune deficiencies and allograft
This is why diagnosis of celiac is based on several criteria, not just one.
".... Instead we find clinically useful the shifting to a quantitative approach that can be defined as the "4 out of 5" rule: the diagnosis of celiac disease is confirmed if at least 4 of the following 5 criteria are satisfied: typical symptoms of celiac disease; positivity of serum celiac disease immunoglobulin, A class autoantibodies at high titer; human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes; celiac enteropathy at the small bowel biopsy; and response to the gluten-free diet."
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