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The occurrence of terminal ileal histological abnormalities in patients with coeliac disease.
Dig Liver Dis. 2006 Nov; 38(11):815-9.DL

Abstract

INTRODUCTION

Coeliac disease causes histological changes throughout the small bowel, but is often a proximal lesion. We wanted to assess whether terminal ileal histological abnormalities occurred more commonly in patients with coeliac disease and if specific assessment of intraepithelial lymphocytes increases the recognition of undiagnosed coeliac disease.

METHODS

Terminal ileal biopsies were prospectively examined over a 3-year period (April 2001-May 2004). Patients were included if they were found to have a synchronous duodenal biopsy that gave a new diagnosis of coeliac disease (n=20). Terminal ileal biopsies taken at colonoscopy during the same period were also examined from four groups of patients: coeliac disease established on a gluten-free diet but with persisting symptoms (n=25), inflammatory bowel disease (n=47), chronic diarrhoea (n=44) and polyp surveillance (n=47). All biopsies were graded according to the Marsh criteria and an intraepithelial lymphocytes count per 100 enterocytes was obtained.

RESULTS

There was only one patient from all five groups who had villous atrophy of the terminal ileal. This patient had a new diagnosis of coeliac disease. The mean intraepithelial lymphocytes count in the coeliac disease group was 23.7 intraepithelial lymphocytes/100 enterocytes. This was significantly higher than the control groups: coeliac disease on a gluten-free diet=17.5 (p<0.012), inflammatory bowel disease=12.3 (p<0.0001), diarrhoea=12.6 (p<0.0001) and polyp=13.7 (p<0.0002). Validating terminal ileal villous intraepithelial lymphocytes counts as a test for coeliac disease using an intraepithelial lymphocytes/100 enterocytes of >25 gives a sensitivity of 45% and a specificity of 97.8%.

CONCLUSION

Routinely quantifying terminal ileal intraepithelial lymphocytes may be of limited clinical value. However, subjective recognition of raised intraepithelial lymphocytes on a terminal ileal biopsy should alert the clinician to the possibility of coeliac disease.

Authors+Show Affiliations

Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom. andydhopper@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16787773

Citation

Hopper, A D., et al. "The Occurrence of Terminal Ileal Histological Abnormalities in Patients With Coeliac Disease." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 38, no. 11, 2006, pp. 815-9.
Hopper AD, Hurlstone DP, Leeds JS, et al. The occurrence of terminal ileal histological abnormalities in patients with coeliac disease. Dig Liver Dis. 2006;38(11):815-9.
Hopper, A. D., Hurlstone, D. P., Leeds, J. S., McAlindon, M. E., Dube, A. K., Stephenson, T. J., & Sanders, D. S. (2006). The occurrence of terminal ileal histological abnormalities in patients with coeliac disease. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 38(11), 815-9.
Hopper AD, et al. The Occurrence of Terminal Ileal Histological Abnormalities in Patients With Coeliac Disease. Dig Liver Dis. 2006;38(11):815-9. PubMed PMID: 16787773.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The occurrence of terminal ileal histological abnormalities in patients with coeliac disease. AU - Hopper,A D, AU - Hurlstone,D P, AU - Leeds,J S, AU - McAlindon,M E, AU - Dube,A K, AU - Stephenson,T J, AU - Sanders,D S, Y1 - 2006/06/19/ PY - 2006/02/15/received PY - 2006/04/10/accepted PY - 2006/6/22/pubmed PY - 2007/2/9/medline PY - 2006/6/22/entrez SP - 815 EP - 9 JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis VL - 38 IS - 11 N2 - INTRODUCTION: Coeliac disease causes histological changes throughout the small bowel, but is often a proximal lesion. We wanted to assess whether terminal ileal histological abnormalities occurred more commonly in patients with coeliac disease and if specific assessment of intraepithelial lymphocytes increases the recognition of undiagnosed coeliac disease. METHODS: Terminal ileal biopsies were prospectively examined over a 3-year period (April 2001-May 2004). Patients were included if they were found to have a synchronous duodenal biopsy that gave a new diagnosis of coeliac disease (n=20). Terminal ileal biopsies taken at colonoscopy during the same period were also examined from four groups of patients: coeliac disease established on a gluten-free diet but with persisting symptoms (n=25), inflammatory bowel disease (n=47), chronic diarrhoea (n=44) and polyp surveillance (n=47). All biopsies were graded according to the Marsh criteria and an intraepithelial lymphocytes count per 100 enterocytes was obtained. RESULTS: There was only one patient from all five groups who had villous atrophy of the terminal ileal. This patient had a new diagnosis of coeliac disease. The mean intraepithelial lymphocytes count in the coeliac disease group was 23.7 intraepithelial lymphocytes/100 enterocytes. This was significantly higher than the control groups: coeliac disease on a gluten-free diet=17.5 (p<0.012), inflammatory bowel disease=12.3 (p<0.0001), diarrhoea=12.6 (p<0.0001) and polyp=13.7 (p<0.0002). Validating terminal ileal villous intraepithelial lymphocytes counts as a test for coeliac disease using an intraepithelial lymphocytes/100 enterocytes of >25 gives a sensitivity of 45% and a specificity of 97.8%. CONCLUSION: Routinely quantifying terminal ileal intraepithelial lymphocytes may be of limited clinical value. However, subjective recognition of raised intraepithelial lymphocytes on a terminal ileal biopsy should alert the clinician to the possibility of coeliac disease. SN - 1590-8658 UR - https://www.unboundmedicine.com/medline/citation/16787773/The_occurrence_of_terminal_ileal_histological_abnormalities_in_patients_with_coeliac_disease_ DB - PRIME DP - Unbound Medicine ER -