Search the Community

Celiac.com 07/20/2015 - Lymphocytic gastritis (LG) is an uncommon gastric disorder with varying symptoms and endoscopic manifestations. LG, along with two forms of H. pylori-negative gastritis [chronic active gastritis (CAG) and chronic inactive gastritis (CIG)], appears to be more common in patients with celiac disease, based on single-center studies. A team of researchers set out to compare the prevalence of LG, CAG and CIG among those with normal duodenal histology or non-specific duodenitis, and those with celiac disease, as defined by villous atrophy, Marsh 3. The research team included B. Lebwohl, P. H. R. Green, and R. M. Genta. The are variously affiliated with The Department of Medicine, Coeliac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, The Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA, the Miraca Life Sciences, Irving, TX, USA, and the Departments of Pathology and Medicine (Gastroenterology), UT Southwestern Medical Center, Dallas, TX, USA The team analyzed all concurrent gastric and duodenal biopsy specimens submitted to a national pathology laboratory during a 6-year period. They then performed multiple logistic regression to identify independent predictors of each gastritis subtype. They found that a total of 287,503 patients underwent concurrent gastric and duodenal biopsy, with an average age of 52, and most (67%) being female. Compared to patients with normal duodenal histology, LG was more common in partial villous atrophy (OR: 37.66; 95% CI: 30.16–47.03), and subtotal/total villous atrophy (OR: 78.57; 95% CI: 65.37–94.44). Celiac disease was also more common in CAG (OR for partial villous atrophy 1.93; 95% CI: 1.49–2.51, OR for subtotal/total villous atrophy 2.42; 95% CI: 1.90–3.09) and was similarly associated with CIG (OR for partial villous atrophy 2.04; 95% CI: 1.76–2.35, OR for subtotal/total villous atrophy 2.96; 95% CI: 2.60–3.38). From this study, the team concluded that lymphocytic gastritis is strongly associated with celiac disease, with increasing prevalence correlating with more advanced villous atrophy. Chronic active gastritis and chronic inactive gastritis are also significantly associated with celiac disease. Future research should measure the natural history of these conditions after treatment with a gluten-free diet. Source: Alimentary Pharmacology & Therapeutics Volume 42, Issue 2, pages 180–187, July 2015. DOI: 10.1111/apt.13249

Celiac.com 09/08/2014 - Currently, physicians trying to diagnose celiac disease in patients with lymphocytic enteritis look for subepithelial deposits of anti-tissue transglutaminase IgA. However, it is known that an increase in CD3+TCRγδ+ coupled with a decrease in CD3- intraepithelial lymphocytes (IEL) is a flow cytometric pattern clearly indicating celiac disease with atrophy. To determine which method yielded better diagnostic results, a research team set out to compare and contrast intestinal intraepithelial lymphocyte cytometric pattern with subepithelial deposits of anti-tissue transglutaminase IgA for diagnosing lymphocytic enteritis due to celiac disease. The researchers included F. Fernández-Bañares, A. Carrasco, R. García-Puig, M. Rosinach, C. González, M. Alsina, C. Loras, A. Salas, J.M. Viver, M. Esteve. They are variously affiliated with the Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), the Department of Pediatrics, Hospital Universitari Mutua Terrassa, University of Barcelona, the Department of Pathology, Hospital Universitari Mutua Terrassa, University of Barcelona, CIBERehd, Terrassa, and the Department of Immunology, CATLAB, Viladecavalls, all in Barcelona, Spain. For their study, the team evaluated 144 women and 61 men, with positive celiac genetics, who underwent duodenal biopsy for celiac disease. Fifty patients showed villous atrophy, and 70 showed lymphocytic enteritis, while 85 showed normal histology. Eight patients with non-celiac atrophy and 15 with lymphocytic enteritis secondary to Helicobacter pylori served as control group. The team used duodenal biopsies to assess both celiac disease, IEL flow cytometric (complete or incomplete), and IF patterns. Sensitivity of IF, and complete and incomplete cytometric patterns for celiac disease diagnosis in patients with positive serology (Marsh 1+3) was 92%, 85% and 97% respectively, but only the complete cytometric pattern showed 100% specificity. Twelve seropositive and 8 seronegative Marsh 1 patients received a celiac disease diagnosis at the beginning of the study or after gluten free-diet, respectively. For celiac disease diagnosis in lymphocytic enteritis at baseline, cytometric pattern yielded better diagnostic results than both IF pattern and serology (95% vs 60% vs 60%, p = 0.039). Analysis of the IEL flow cytometric pattern offers fast, accurate reliable way to spot celiac disease in the initial diagnostic biopsy of patients presenting with lymphocytic enteritis, even for patients with negative blood screens, and seems superior to anti-TG2 intestinal deposits. These results support the analysis of the IEL flow cytometric pattern as the best way to spot celiac disease at the first diagnostic biopsy of patients presenting with lymphocytic enteritis, even for patients with negative blood screens. Source: PLoS One. 2014 Jul 10;9(7):e101249. doi: 10.1371/journal.pone.0101249.

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. Source: Aliment Pharmacol Ther. 2010 Dec;32(11-12):1392-7.