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Histology of the terminal ileum in coeliac disease.
Scand J Gastroenterol. 2004 Jul; 39(7):665-7.SJ

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 > or =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.

Authors+Show Affiliations

Depts. of Gastroenterology and Histopathology, Altnagelvin Hospital, Londonderry, Northern Ireland BT47 6SB, UK. wildickey@aol.comNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15370688

Citation

Dickey, W, and D F. Hughes. "Histology of the Terminal Ileum in Coeliac Disease." Scandinavian Journal of Gastroenterology, vol. 39, no. 7, 2004, pp. 665-7.
Dickey W, Hughes DF. Histology of the terminal ileum in coeliac disease. Scand J Gastroenterol. 2004;39(7):665-7.
Dickey, W., & Hughes, D. F. (2004). Histology of the terminal ileum in coeliac disease. Scandinavian Journal of Gastroenterology, 39(7), 665-7.
Dickey W, Hughes DF. Histology of the Terminal Ileum in Coeliac Disease. Scand J Gastroenterol. 2004;39(7):665-7. PubMed PMID: 15370688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Histology of the terminal ileum in coeliac disease. AU - Dickey,W, AU - Hughes,D F, PY - 2004/9/17/pubmed PY - 2005/4/6/medline PY - 2004/9/17/entrez SP - 665 EP - 7 JF - Scandinavian journal of gastroenterology JO - Scand J Gastroenterol VL - 39 IS - 7 N2 - 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 > or =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. SN - 0036-5521 UR - https://www.unboundmedicine.com/medline/citation/15370688/Histology_of_the_terminal_ileum_in_coeliac_disease_ L2 - https://www.tandfonline.com/doi/full/10.1080/00365520410004901 DB - PRIME DP - Unbound Medicine ER -