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Histology of the Terminal Ileum in Celiac Disease

Scandinavian Journal of Gastroenterology, Volume 39, Number 7 / July 2004, 665 - 667

Celiac.com 06/28/2004 – The results of this study indicate that the damage caused by celiac disease can be more extensive than once thought, and that it likely affects the entire small bowel, rather than just the lamina propria and crypt regions. These results also give gastroenterologists more tools for discovering the disease, as they can now find indications of it when doing a colonoscopy, which is typically done to screen for other disorders such as colon cancer. If all gastroenterologists follow these new recommendations it will speed up a celiac disease diagnosis for many people, and will also help prevent missed diagnoses.

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W. Dickey and D. F. Hughes
Depts. of Gastroenterology and Histopathology Altnagelvin Hospital Londonderry Northern Ireland
Abstract:
Background: The histological lesion of gluten sensitivity primarily affects the proximal small bowel. The purpose of this study was to assess whether there were features of gluten-sensitive enteropathy in biopsies taken from the terminal ileum during colonoscopy/ileoscopy. Specific and sensitive abnormalities might facilitate diagnosis of coeliac disease in patients undergoing colonoscopy as their initial procedure or help select those who should proceed to upper gastrointestinal endoscopy and duodenal biopsy.
Methods: Terminal ileal biopsies, taken from 30 patients with duodenal villous atrophy consistent with coeliac disease and from 60 control patients with no evidence of coeliac or inflammatory bowel disease, were reviewed blindly and compared. Biopsies were assessed for the presence or absence of villous atrophy and crypt hyperplasia, and counts were made of intraepithelial lymphocytes (IELs).
Results: One patient only, in the coeliac group, had partial villous atrophy with crypt hyperplasia in the terminal ileum. IEL counts were significantly higher (P<0.005) in the coeliac group than among controls (mean per 100 enterocytes 26 versus 10). An ileal IEL count and 25 had a sensitivity for duodenal villous atrophy (VA) of 60% and specificity of 100%.
Conclusions: Coeliac disease may affect the entire small bowel. Increased IEL density in the terminal ileum is associated with duodenal VA and should prompt a search for coeliac disease by serology and duodenal biopsy. Conversely, a normal IEL count does not allow the exclusion of coeliac disease with confidence.

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