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  • Jefferson Adams
    Jefferson Adams

    Celiac Disease and the Etiology of Lymphocytic Duodenosis: A Prospective Study

    Reviewed and edited by a celiac disease expert.

    Caption: According to this study 16% of those with lymphocytic duodenosis have celiac disease.

    Celiac.com 12/29/2010 - A team of researchers recently conducted a prospective study the etiology of lymphocytic duodenosis. Among their findings are that sixteen percent of patients with lymphocytic duodenosis have celiac disease.

    The research team was made up of I. Aziz, K. E. Evans, A. D. Hopper, D. M. Smillie, and D. S. Sanders. They are affiliated with the Department of Gastroenterology at Royal Hallamshire Hospital in Sheffield, UK.

    The study came in response to earlier retrospective studies that have suggested different connections with lymphocytic duodenosis, indicating that patients with this condition should not be diagnosed with celiac disease, solely by histology.

    Lymphocytic duodenosis is marked by normal villous architecture and less than 25 intraepithelial lymphocytes (IELs) per 100 enterocytes.

    For their study, the team thoroughly evaluated one hundred patients with lymphocytic duodenosis for celiac disease and other aspects associatedwith lymphocytic duodenosis by using initial celiac blood screens, and excluding the presence of infection.

    Of thirty-four patients with unexplained lymphocytic duodenosis, twenty-nine underwent repeat duodenal biopsies following a gluten challenge. Biopsy results showed that 16% of patients with lymphocytic duodenosis had celiac disease.

    Once celiac disease was accounted for, the factors most commonly association with lymphocytic duodenosis were as follows: drugs were a factor in twenty-one percent of lymphocytic duodenosis patients; infection was a factor in nineteen percent, immune dysregulation was a factor in four percent, inflammatory bowel disease and microscopic colitis in two percent each, sarcoidosis and IgA deficiency in one percent of cases, respectively.

    Of thirty-four patients with no known associations, eighteen showed symptoms of irritable bowel syndrome (IBS). Of twenty-nine patients examined with repeat duodenal biopsies, the IEL count returned to normal in twenty-two patients.

    The study results show that known associations can be found in sixty-six percent of cases of lymphocytic duodenosis.

    Importantly, sixteen percent will have celiac disease. In cases of lymphocytic duodenosis with no apparent cause, there may be a connection with IBS. In such cases the IEL count returns to normal on repeat biopsy in seventy-six percent.

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    Wish "gluten challenge" was linked to its specifics.

    AFAIK there's little consensus on length of time, quantity of gluten, or even # of times per day to ingest it.

     

    Also, it seems strange that the article doesn't say all 34 were strictly gluten free before the challenge.

    Personally, even when a UK study explicitly says gluten free, my 1st thought is "how much has 'deglutened' wheat starch?"

     

    I've met many on this forum who feel as glutened from 200ppm products as from obvious gluten.

     

    For all we know, another 16% or more showed no change w/ gluten challenge because they were never all that gluten free to begin with.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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