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Showing results for tags 'villous'.
Found 16 results
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Celiac.com 11/16/2017 - If people with celiac disease hope to avoid complications, then it's important for their gut mucosa to heal. However, besides biopsy, there is currently no good way for doctors to assess that a patient has healed enough to experience full remission. A team of researchers recently set out to assess the role of a point-of-care test (POCT) based on IgA/IgG-deamidated gliadin peptide, in detecting persistent villous atrophy in celiac disease. The research team included Michelle S Lau, Peter D Mooney, William L White, Michael A Rees, Simon H Wong, Matthew Kurien, Nick Trott, Daniel A Leffler, Marios Hadjivassiliou and David S Sanders. They are affiliated with the Academic Department of Gastroenterology at Royal Hallamshire Hospital, Sheffield Teaching Hospitals, in Sheffield, UK, and with the Celiac Center and Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA. The research team recruited celiac disease patients undergoing endoscopy for the assessment of histological remission. All patients had IgA-endomysial (EMA) antibodies, IgA-tissue transglutaminase (TTG) antibodies, received a POCT, and completed a validated dietary questionnaire. All patients received a gastroscopy, with four biopsies taken from the second part of the duodenum and one from the duodenal bulb. The research team then compared the diagnostic performance of the surrogate markers against duodenal histology as the reference standard. From 2013 to 2017, the team evaluated a total of 217 celiac disease patients. 70% of patients were female, ranging in age from 16–83 years, with an average age of 53 years. Patients had been on a gluten-free diet for an average of 6 years when recruited. Eighty-five (39.2%) patients had persistent villous atrophy. The sensitivities of the POCT, TTG, EMA, and the adherence score in detecting villous atrophy were 67.1%, 44.7%, 37.7%, and 24.7% respectively (P=0.0005). The combination of the POCT and adherence score only marginally increased the sensitivity to 70.6% (59.7–80.0%). The POCT showed a higher sensitivity than the other markers in predicting villous atrophy. A POCT may help doctors get a quick, accurate assessment of mucosal healing levels during simple follow-up office visits. Source: The American Journal of Gastroenterology , (10 October 2017). doi:10.1038/ajg.2017.357 -
Celiac.com 01/09/2017 - Some researchers have criticized the usefulness of the 7 level Marsh-Oberhuber classification of mucosal damage in patients with celiac disease. Even though assessing duodenal biopsies with dissecting microscopy is a somewhat crude method, it can provide useful information in cases of obvious villous atrophy. For the past 15 years, one research team has analyzed duodenal biopsies with dissecting microscopy before sending them to the pathology department for histology. Their feeling is that, if dissecting microscopy and traditional histology were comparable, the grading of the histological lesion would be unnecessary, or even pointless, for proper diagnosis of most enteropathies. That research team recently set out to settle that question. The team included F Biagi, C Vattiato, M Burrone, A Schiepatti, S Agazzi, G Maiorano, O Luinetti, C Alvisi, C Klersy, and GR Corazza. They are variously affiliated with the First Department of Internal Medicine, the Biometry and Statistics, the Department of Pathology at University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and with the Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy. They conducted a retrospective analysis of the clinical notes of all 2,075 patients undergoing duodenal biopsy between September 1999 and June 2015. They collected and statistically compared the results of duodenal mucosal evaluation with both dissecting microscopy and traditional histology. Their results, using κ statistics, showed a substantial agreement of the two methods (κ statistics 0.78). Sensitivity of dissecting microscopy for detection of severe villous atrophy was 85.1% (95% CI 81.2% to 88.5%) and specificity was 95% (95% CI 93.8% to 96%). Although dissecting microscopy is no substitute for traditional histology, these results suggest that most celiac disease-related and other flat enteropathies can be sufficiently diagnosed without grading villous atrophy. Source: J Clin Pathol. 2016 Dec;69(12):1051-1054. doi: 10.1136/jclinpath-2016-203711. Epub 2016 May 4. -
Celiac.com 11/10/2016 - Seronegative villous atrophy (SNVA) is commonly attributed to celiac disease. However, celiac is not the sole cause of SNVA. Recent reports have pointed to a connection with angiotensin-2-receptor-blockers (A2RBs), but data on such cases of SNVA was limited to centers dealing with complex case referrals, and not SNVA in general. A team of researchers recently completed a clinical and phenotypical assessment of SNVA over a 15-year period. The research team included I Aziz, MF Peerally, JH Barnes, V Kandasamy, JC Whiteley, D Partridge, P Vergani, SS Cross, PH Green, DS Sanders. They are variously affiliated with the Academic Department of Gastroenterology, the Department of Microbiology, the Department of Histopathology at the Royal Hallamshire Hospital in Sheffield, UK, and with the Department of Medicine, Columbia University College of Physicians and Surgeons, Celiac Disease Center, New York, New York, USA. Over a 15-year period (2000-2015) the team assessed 200 adult patients with SNVA. Patients were diagnosed with either seronegative celiac disease (SNCD) or seronegative non-celiac disease (SN-non-celiac disease). The team then made baseline comparisons between the groups, with 343 seropositive celiac disease patients serving as controls. Of the 200 SNVA cases, SNCD represented 31% (n=62) and SN-non-celiac disease 69% (n=138). The human leucocyte antigen (HLA)-DQ2 and/or DQ8 genotype was present in 61%, with a 51% positive predictive value for SNCD. The breakdown of identifiable causes in the SN-non-celiac disease group comprised infections (27%), inflammatory/immune-mediated disorders (17.5%) and drugs (6.5%; two cases related to A2RBs). However, the researchers found no obvious cause in 18%, while duodenal histology spontaneously normalized in 72% of SNVA patients, while those patients were consuming a gluten-enriched diet. Following multivariable logistic regression analysis, the only independent factor associated with SN-non-celiac disease was non-white ethnicity (OR 10.8, 95% CI 2.2 to 52.8); in fact, 66% of non-white patients showed GI infections. On immuno-histochemistry all groups stained positive for CD8-T-cytotoxic intraepithelial lymphocytes. However, additional CD4-T helper intraepithelial lymphocytes were occasionally seen in SN-non-celiac disease mimicking the changes associated with refractory celiac disease. Most patients with SNVA, especially non-white patients, do not have celiac disease. Furthermore, a subgroup of patients with no obvious cause for their SNVA will show spontaneous histological resolution while consuming gluten. Based on these findings, the researchers encourage doctors to investigate patient condition before prescribing a gluten-free diet. Source: Gut. 2016 Sep 7. pii: gutjnl-2016-312271. doi: 10.1136/gutjnl-2016-312271. -
Celiac.com 08/24/2016 - Although serological tests are useful for identifying celiac disease, it is well known that a small minority of celiacs are seronegative, and show no blood markers for celiac disease. A team of researchers wanted to define the prevalence and features of seronegative compared to seropositive celiac disease, and to establish whether celiac disease is a common cause of seronegative villous atrophy. The research team included U Volta, G Caio, E Boschetti, F Giancola, KJ Rhoden, E Ruggeri, P Paterini, and R De Giorgio. They are all affiliated with the Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy. They looked at clinical, histological and laboratory findings from 810 celiac disease diagnoses, and retrospectively characterized seronegative patients. Of the original 810 patients, they found fourteen patients who fulfilled diagnostic criteria for seronegative celiac disease, which were antibody negativity, villous atrophy, HLA-DQ2/-DQ8 positivity and clinical/histological improvement after gluten free diet. Their review showed that, compared to seropositive patients, seronegative celiac patients showed a significantly higher median age at diagnosis and a higher prevalence of classical phenotype, such as malabsorption, along with autoimmune disorders and severe villous atrophy. The most common diagnosis in the 31 cases with seronegative flat mucosa was celiac disease at 45%, along with Giardiasis at 20%, common variable immunodeficiency at 16%, and autoimmune enteropathy at 10%. Although rare, seronegative celiac disease is the most common cause of seronegative villous atrophy with a high median age at diagnosis; a close association with malabsorption and flat mucosa; and a high prevalence of autoimmune disorders. Physicians treating seronegative villous atrophy should consider seronegative celiac disease as a possibility. Source: Dig Liver Dis. 2016 Jun 11. pii: S1590-8658(16)30460-1. doi: 10.1016/j.dld.2016.05.024.
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Celiac.com 03/13/2015 - People who suffer from celiac disease with persistent villous atrophy do not face any higher risk of ischemic heart disease or atrial fibrillation, according to a recent study by a research team in Sweden. This is important, because patients with celiac disease do face an increased risk of death from cardiovascular causes, so it is mildly encouraging that persistent villous atrophy resulting from gluten exposure does not appear to affect overall or cardiovascular mortality. The research team, led by Dr. Jonas F. Ludvigsson from Karolinska University Hospital in Stockholm, studied 7,440 celiac disease patients, 43% with persistent villous atrophy, who had follow-up biopsies, along with up to five controls each, matched for age, gender, county, and calendar year. Overall risk of ischemic heart disease was not significantly higher in the patients with celiac disease. After adjusting for age at follow-up biopsy, gender, duration of celiac disease, and other factors, they found no significant difference in the risk of ischemic heart disease risk between patients with villous atrophy and those with mucosal healing. Similarly, patients with villous atrophy had no higher risk of atrial fibrillation than those with mucosal healing. Factors associated with ischemic heart disease risk included being male, older, and having lower educational levels. Factors associated with atrial fibrillation risk included being male and being older. Source: Open Original Shared Link -
Celiac.com 06/06/2014 - Celiac disease guidelines suggest that some patients with high anti-tTG ab levels might be diagnosed without biopsy. A team of Indian researchers recently reviewed their celiac disease database to determine if anti-tissue transglutaminase (tTG) antibody (ab) titers correlate with severity of villous abnormalities in Indian patients, and to find out a cutoff value of anti-tTG ab fold-rise that might best predict celiac disease. The researchers included P. Singh, L. Kurray, A. Agnihotri, P. Das, A.K. Verma, V. Sreenivas, S. Datta Gupta, and G.K. Makharia. The are affiliated with the Departments of Gastroenterology and Human Nutrition, Pathology, and Biostatistics at the All India Institute of Medical Sciences in New Delhi, India. The team reviewed data on 366 anti-tTG ab-positive individuals who received duodenal biopsies. The team conducted anti-tTG ab screens before patients began a gluten-free diet, and they expressed anti-tTG ab results in terms of fold-rise by calculating ratio of observed values with cutoff value. Celiac disease was diagnosed only in patients with positive serology, villous atrophy greater than Marsh grade 2, and clear response to gluten-free diet. Average anti-tTG fold-rise in groups with Marsh grade ≤2 was 2.6 (±2.5), grade 3a was 4.0 (±3.9), 3b was 5.7 (±5.1), and 3c was 11.8 (±8.0). Overall positive likelihood ratio for diagnosing celiac disease was 15.4 and 27.4 at 12- and 14-fold-rise of anti-tTG ab titer, respectively. The positive predictive value of diagnosis of celiac disease was 100% when anti-tTG ab titer was 14-fold higher over the cutoff value. Fifty-seven (43.9%) patients with anti-tTG titer rise less than 2-fold also had celiac disease. Levels of anti-tTG rise directly with severity of villous abnormality. High anti-tTG ab titers indicate likely villous atrophy. Contrary to emerging wisdom, even patients with anti-tTG ab levels less than 2-times baseline should receive mucosal biopsies, because many patients with celiac disease have such low levels. Source: J Clin Gastroenterol. 2014 Feb 27. -
Celiac.com 05/26/2014 - Villous atrophy with intraepithelial lymphocytosis is the classic confirmation of of celiac disease. However, data show varying rates of mucosal recovery among individuals. A research team recently sought gauge the impact of age and other demographic variables on the likelihood of persistent villous atrophy in celiac disease with follow-up biopsy. The research team included B. Lebwohl, J. A. Murray, A. Rubio-Tapia, P. H. R. Green, and J. F. Ludvigsson. They are variously affiliated with the Celiac Disease Center of the Department of Medicine at Columbia University College of Physicians and Surgeons in New York, NY., the Clinical Epidemiology Unit of the Department of Medicine at Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden, the Division of Gastroenterology and Hepatology of the Department of Medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota, and the Department of Pediatrics of Örebro University Hospital in Örebro, Sweden. For their study, the team reviewed data on patients with villous atrophy on duodenal histology from all 28 Swedish pathology departments from 1969–2008. They looked at age, gender, calendar period, duration of disease and educational attainment to determine predictors of persistent villous atrophy. They found that, of 7,648 celiac disease patients who received follow-up biopsy, 3,317 patients showed clear persistent villous atrophy (43%; 95% CI 42–44%). Persistent villous atrophy rise with patient age, with 56% of those 70 years of age or older, compared to 17% among those younger than 2 years. In contrast, persistent villous atrophy did not vary widely by age in earlier years. Multivariate analysis showed that, 2–5 years after celiac disease diagnosis, persistent villous atrophy was more common among males (OR 1.43; 95% CI 1.07–1.90), and less common in more highly educated patients (OR for college degree vs. Overall, rates of persistent villous atrophy have changed over time, with greater rates of healing in recent years. Social differences in persistent villous atrophy suggest that levels of education regarding the importance of a gluten-free diet can influence mucosal healing. Source: Alimentary Pharmacology & Therapeutics 2014;39(5):488-495.
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Celiac.com 02/19/2014 - Celiac disease have a greater risk of bone fracture than non-celiacs; a risk that persists after diagnosis. Also a substantial number of celiac patients display signs of persistent villous atrophy on follow-up biopsy. A team of researchers recently set out to determine whether persistent villous atrophy impacts long-term fracture risk. The research team included Benjamin Lebwohl, Karl Michaëlsson, Peter H. R. Green and Jonas F. Ludvigsson. They are variously affiliated with the Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; the Clinical Epidemiology Unit of the Department of Medicine at Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden; the Department of Surgical Sciences, Section of Orthopaedics at Uppsala University in Upsalla Sweden; and Department of Pediatrics at Örebro University Hospital in Örebro, Sweden. First, the team identified all patients in Sweden with histological evidence of celiac disease who underwent a follow-up biopsy and compared patients with persistent villous atrophy with those with mucosal healing. The team then recorded data for all known general fractures; for likely osteoporotic fractures (of hip, distal forearm, thoracic and lumbar spine, or proximal humerus); and all known hip fractures. Follow-up biopsies showed villous atrophy in 43% of the 7,146 patients. The results showed no significant connection between persistent villous atrophy and overall fractures. The hazard ratio (HR) for persistent villous atrophy compared with those with healing was 0.93, with a 95% confidence interval (CI 0.82–1.06). Nor was there a connection between persistent villous atrophy and likely osteoporotic fractures (HR 1.11, 95% CI 0.84–1.46). Results did show that persistent villous atrophy was connected with an increased risk of hip fracture (HR 1.67, 95% CI 1.05–2.66). The risk of hip fracture rose in relation to the degree of villous atrophy; the more villous atrophy, the higher the risk of hip fracture. Overall, HR for partial villous atrophy compared with those with healing was 1.70, with a 95% CI 0.82–3.49 (HR for subtotal/total villous atrophy compared with those with healing 2.16, 95% CI 1.06–4.41). The results indicate that persistent villous atrophy on follow-up biopsy can be used to predict the risk of hip fracture in patients with celiac disease. The connection between persistent villous atrophy and hip fractures, but not fractures overall, implies that the increased fracture risk is due to thinner sc tissue, and fall or trauma. Source: The Journal of Clinical Endocrinology & Metabolism. DOI: http://dx.doi.org/10.1210/jc.2013-3164 -
Celiac.com 06/27/2013 - Patients with villous atrophy and negative celiac disease serologies pose a diagnostic and therapeutic dilemma. When doctors are unable to determine what is causing villous atrophy in a patient without celiac disease, they usually classify it as a case of "unclassified sprue." However, doctors currently know very little about the best way to treat and manage cases of unclassified sprue. To get a better picture of this dilemma, a team of researchers recently examined the connections between villous atrophy and negative celiac serology. The research team included M. Degaetani, C.A. Tennyson, B. Lebwohl, S.K. Lewis, H. Abu Daya, C. Arguelles-Grande, G. Bhagat G, and P.H. Green. They are variously affiliated with the Celiac Disease Center, and the Department of Medicine at Columbia University College of Physicians and Surgeons at Columbia University Medical Center in New York, USA. For their study, the team looked at adult patients with biopsy-proven villous atrophy and negative celiac serology, evaluated at our tertiary referral center over a 10-year period. They noted test results for HLA DQ2/8 alleles, antienterocyte antibodies, giardia stool antigen, bacterial overgrowth, total serum immunoglobulins, and HIV. They also recorded treatment, response, and repeat-biopsy findings for each patient. They found that most of the 72 cases were classified as seronegative celiac disease, medication-related villous atrophy, and unclassified sprue. The majority of patients diagnosed with unclassified sprue reported symptomatic improvement with immunosuppressive therapy. Some patients diagnosed with unclassified sprue were found to have villous atrophy associated with the use of olmesartan. The team encourages further examination of the role of medications in the development of villous atrophy, along with the optimal dose and length of immunosuppression for patients with unclassified sprue. Source: Am J Gastroenterol. 2013 May;108(5):647-53. doi: 10.1038/ajg.2013.45. -
Oats Induce Villous Atrophy in Some Celiacs
Scott Adams posted an article in Oats: Are They Gluten-Free?
Gut 2003;52:1649-1652 Celiac.com 11/05/2003 - A study conducted by Norwegian researchers has found that some patients with celiac disease may not be able to tolerate oats, especially those who also have Dermatitis Herpetiformis. The researchers looked at 19 adult celiac disease patients who were given 50g of uncontaminated oats per day for 12 weeks. The patients were given biopsies before and after the challenge and were scored histologically, and "levels of mRNA specific for interferon were determined by reverse transcription-polymerase chain reaction analysis." The researchers determined that oats were well tolerated by most celiac patients, with the exception of several who reported initial abdominal discomfort and boating, and one patient who eventually developed total villous atrophy and "dramatic dermatitis during a second challenge." Further, five of the patients showed positive levels of interferon mRNA after challenge, which leads to some concern by the researchers regarding the safety of oats for those with celiac disease. Several larger studies have demonstrated that oats are well tolerated by most celiacs. -
Celiac.com 02/06/2013 - Villous atrophy (VA) in the small intestine is one of the prime features of celiac disease, and has been associated with increased mortality, but it is unknown if mortality is influenced by mucosal recovery. To better understand the relationship between mucosal healing and mortality in celiac disease, a research team set out to determine whether persistent villous atrophy is associated with mortality in celiac disease patients. The research team included B. Lebwohl, F. Granath, A. Ekbom, S.M. Montgomery, J.A. Murray, A. Rubio-Tapia, P.H. Green, and J.F. Ludvigsson. They are variously affiliated with the Celiac Disease Center at the Department of Medicine of Columbia University College of Physicians and Surgeons in New York, NY, the Clinical Epidemiology Unit at the Department of Medicine of Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden. The team used biopsy reports from every pathology department (n = 28) in Sweden to identified 7,648 individuals with celiac disease, which they defined as the presence of villous atrophy, and who had undergone a follow-up biopsy within 5 years of diagnosis. They used Cox regression to assess mortality according to follow-up biopsy. Celiac patients were 28.4 years of age, on average, and 63% were female. The average follow-up after diagnosis was 11.5 years. Overall, patients who underwent follow-up biopsy had lower mortality rates than those who did not undergo follow-up biopsy (Hazard Ratio 0.88, 95% CI: 0.80-0.96). Of the 7648 patients who underwent follow-up biopsy, 3317 (43%) showed persistent villous atrophy. In all, 606 (8%) patients died. However, patients with persistent villous atrophy died at about the same rates as those with mucosal healing (HR: 1.01; 95% CI: 0.86-1.19). Also, children with persistent villous atrophy showed no increase in mortality (HR: 1.09 95% CI: 0.37-3.16) or adults (HR 1.00 95% CI: 0.85-1.18), including adults older than age 50 years (HR: 0.96 95% CI: 0.80-1.14). Mortality rates for celiac patients with persistent villous atrophy are about the same as for celiac patients with healthy guts. So, persistent villous atrophy is not tied to higher mortality for celiac disease patients. That means that even though a follow-up biopsy will help doctors to spot refractory disease in symptomatic patients, persistent villous atrophy is not useful in predicting future mortality. Source: Aliment Pharmacol Ther. 2013 Feb;37(3):332-9. doi: 10.1111/apt.12164.
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Celiac.com 09/23/2011 - Despite the current sensitivity and specificity of blood tests, a small bowel biopsy showing villous atrophy remains the international gold standard for diagnosing celiac disease. Yet the small intestine is actually quite long, and villous atrophy can be dispersed throughout and therefore potentially missed, especially in children. Experts recommend that at least four tissue samples be taken to circumvent this problem, but have not specified the optimal sites from which to take the samples. Jejunal biopsies have historically been performed, but they are uncomfortable for the patient and technically complicated. Duodenal biopsies are safer and easier, and there is even some data suggesting that the duodenal bulb may be the only site of villous atrophy in patients newly diagnosed with celiac disease. Yet it was not known whether biopsy of the duodenal bulb alone would be sufficient to identify established celiac disease in adult patients. A recent study aimed to compare histology of the duodenal bulb in adults with newly diagnosed celiac disease, established celiac disease, and no celiac disease. They found that villous atrophy may in fact only be present in the duodenal bulb, and that this is therefore the optimal site for biopsy in diagnosing celiac disease. Four hundred and sixty-one patients were analyzed, with a mean age of 51 years. They were recruited from a hospital in the United Kingdom between November 2008 and July 2010. Three hundred were women and one hundred and sixty-one were men. One hundred and twenty-six were newly diagnosed with celiac disease; eighty-five had established celiac disease, had been adhering to a gluten free diet, and were undergoing biopsy to histologically assess their remission; and two hundred and fifty were healthy controls. Five biopsies were taken from each patient: one from the duodenal bulb and four from the second part of the duodenum, one from each quadrant. Twenty-three patients exhibited villous atrophy only in the duodenal bulb, and both new and established celiac cases were significantly more likely to exhibit this phenomenon than controls. Most of the patients with lesions of varying severity at different locations had the more severe lesion in the duodenal bulb. Similar results have been achieved with children in other studies. The researchers note that their results are support and are supported by the literature, and conclude that "the optimal strategy for diagnosing celiac disease could only achieve 100% sensitivity by always incorporating a duodenal bulb biopsy." Source: Evans KE, Aziz I, Cross SS, Sahota GR, Hopper AD, Hadjivassiliou M, Sanders DS. A Prospective Study of Duodenal Bulb Biopsy in Newly Diagnosed and Established Adult Celiac Disease. Am J Gastroenterol. 2011 May 24. -
Celiac.com 05/05/2010 - Celiac disease is the most commonly misdiagnosed auto-immune disease of modern times. People that have celiac disease and ingest gluten, have a T-Cell mediated immune reaction which creates damage to the small intestinal mucosa. Mucosa villous atrophy is presented as an abnormality of the small intestine, and results in the flattening of the mucosa, and gives the appearance of atrophy of villi. Clinically, this is found in malabsorbtion syndromes like celiac disease. The degree of damage which occurs in the duodenum can vary, and there is some controversy regarding the coexistence of villous atrophy and normal mucosa found in different biopsy locations. Tests for villous atrophy were conducted at the regional referral center Gastrointestinal Patho-physiology and Endoscopy, University Department of Pediatrics, Children's Hospital, Spedali Civili, Brescia, Italy; and University Department of Pathology II, Spedali Civili, Brescia, Italy, on all children below 2 years of age and all patients with positive serum IgA antibodies or raised serum IgG anti-gliadin antibodies. The central focus of the study was to analyze the variability anddistribution patterns of histological lesions in celiac children. Eachbiopsy taken was thoroughly analyzed, and each type of lesion found wasdocumented. Six hundred and eighty-six children enrolled as patients at the clinic between July 2005 and October 2009, tested positive for celiac disease. Of the 686 celiac patients, none of them had an entirely normal biopsy, 96.2% had some degree of villous atrophy, 80.1% had total villous atrophy, and 46.6% had different lesions in different places. 16.9% or 116 of the patients studied had lesions that varied within the same biopsy. Of those 116 patients, all of them also had histological normal lesions within the same biopsy. There was no determined correlation between distribution and type of histological lesions and medical presentation of celiac disease. In the 800 children with celiac that were evaluated for this and previous studies, there was absolutely no evidence of of any cases where any lesions, including villous atrophy were isolated to the duodenal bulb. Additionally, there were no biopsy's where the intraepithelial lymphocyte (IEL) count was normal, indicating that there is no truly normal duodenal histology in celiac patients. Some variability of histological lesions were found even within the same duodenal biopsy. Not only did this study confirm that duodenal lesions can vary among varying biopsies, it also demonstrated that severity of lesions has a proximal-to-distal gradient, but no patient has a completely normal duodenal biopsy. This discovery of histological variation in celiac biopsy's may help to establish an accurate celiac diagnosis for celiac in the future. Source: The American Journal of Gastroenterology , (6 April 2010) | doi:10.1038/ajg.2010.153 -
Celiac.com 05/08/2007 - A recent study published in the journal Digestive Diseases and Sciences indicates that lesser degrees of villous atrophy correspond to seronegative celiac disease. The study was conducted by researchers J.A. Abrams, B. Diamond, H. Rotterdam, and P.H. Green, of the Department of Medicine, Columbia University College of Physicians and Surgeons in New York City. The research team set out to assess the effectiveness of various serologic tests used to diagnose celiac disease in patients with differing degrees of villous atrophy. The team evaluated 115 adult patients with biopsy-proven celiac disease. All participants met strict criteria, including serologic testing at the time of diagnosis and response to a gluten-free diet, 71% of participants showed total villous atrophy and 29% showed partial villous atrophy. Of those with total villous atrophy, 77% tested positive for endomysial antibody, compared to 33% with partial villous atrophy (P < 0.001). No difference in sensitivity was found between those who classical presentation of celiac disease versus those with silent presentation. Also, patients who were endomysial positive and patients who were endomysial negative showed no difference with respect to age at diagnosis, duration of symptoms, mode of presentation, or family history of celiac disease. Endomysial antibody positivity correlated not with the mode of presentation of celiac disease, but rather, with more severe villous atrophy. Lastly, the study showed that, in clinical practice, serologic tests lack the sensitivity reported in the literature. Digestive Diseases and Sciences, 2004 Apr; 49(4):546-50. health writer who lives in San Francisco and is a frequent author of articles for Celiac.com.
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Dig Dis Sci. 2004 Apr;49(4):546-50 Celiac.com 08/27/2004 – Dr. Peter Green and colleagues at the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, conducted a study designed to determine the sensitivity of the various serological tests used to diagnose celiac disease. To do this they looked at 115 adults with biopsy-proven celiac disease who fulfilled strict criteria which included serological testing at the time of their diagnosis, and a positive response to a gluten-free diet. Out of those studied, 71% had total villous atrophy, and 29% had partial villous atrophy. Serological results indicated that only 77% of those with total and 33% of those with partial villous atrophy actually tested positive for celiac disease, and it did not matter whether the patients presented with classical or silent symptoms. All patients who were positive for anti-tissue transglutaminase had total villous atrophy. The researchers conclude: Seronegative celiac disease occurs. Endomysial antibody positivity correlates with more severe villous atrophy and not mode of presentation of celiac disease. Serologic tests, in clinical practice, lack the sensitivity reported in the literature.
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Gastrointest Endosc. 2004 Jan;59(1):116-8. Celiac.com 06/28/2004 - This study, although small, indicates that there may be additional damage to the second part of the duodenum caused by celiac disease, and that this can also be used for a marker for diagnosing the disease: Dickey W, Hughes D. Department of Gastroenterology, Altnagelvin Hospital, Londonderry, Northern Ireland, UK. BACKGROUND: There are various, well-documented, duodenal endoscopic markers caused by the villous atrophy of celiac disease. Another abnormality seen in association with villous atrophy, erosions in the second part of the duodenum, is described. To our knowledge, this finding has not been heretofore described in patients with celiac disease. METHODS: Five patients with celiac disease and erosions were encountered over a period of 2 years. OBSERVATIONS: The erosions were multiple, superficial, and present in the second part of the duodenum but not the duodenal bulb. All 5 patients had findings typical of celiac disease (iron deficiency, osteopenia/osteoporosis), and 4 had at least one other endoscopic marker: scalloped duodenal folds (3), fold loss (2), or mosaic pattern mucosa (2). These patients represented 7% of new cases of celiac disease during the same time period. This pattern of erosion was not observed in over 1200 other patients undergoing upper endoscopy during the study period. CONCLUSIONS: In a European population, the finding of erosions confined to the second part of the duodenum is specific for villous atrophy, although sensitivity is low. Erosions in the second part of the duodenum should be added to the list of endoscopic markers of celiac disease.
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