Intestinal intraepithelial lymphocyte cytometric pattern is more accurate than subepithelial deposits of anti-tissue transglutaminase IgA for the diagnosis of celiac disease in lymphocytic enteritis

• Published in: PloS one Vol. 9; no. 7; p. e101249
• Main Authors: Fernández-Bañares, Fernando, Carrasco, Anna, García-Puig, Roger, Rosinach, Mercè, González, Clarisa, Alsina, Montserrat, Loras, Carme, Salas, Antonio, Viver, Josep M, Esteve, Maria
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10-07-2014; Public Library of Science (PLoS)
• Subjects: Accuracy; Adolescent; Adult; Aged; Analysis; Atrophy; Autoimmune diseases; Biopsy; CD3 antigen; Celiac disease; Celiac Disease - blood; Celiac Disease - complications; Celiac Disease - diagnosis; Celiac Disease - pathology; Child; Child, Preschool; Diagnosis; Diagnostic systems; Enteritis; Enteritis - complications; Female; Females; Flow Cytometry; Gastroenterology; Gene expression; Genetics; Gluten; GTP-Binding Proteins - immunology; Helicobacter pylori; Histology; Humans; Immunoglobulin A; Immunoglobulin A - blood; Immunoglobulin A - immunology; Immunoglobulins; Infant; Intestinal Mucosa - immunology; Intestine; Lymphocytes; Lymphocytes - pathology; Male; Medical diagnosis; Medicine and Health Sciences; Middle Aged; Patients; Prospective Studies; Research and Analysis Methods; Sensitivity and Specificity; Serologic Tests; Serology; Small intestine; Transglutaminase 2; Transglutaminases - immunology; Young Adult; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0101249

An increase in CD3+TCRγδ+ and a decrease in CD3- intraepithelial lymphocytes (IEL) is a characteristic flow cytometric pattern of celiac disease (CD) with atrophy. The aim was to evaluate the usefulness of both CD IEL cytometric pattern and anti-TG2 IgA subepithelial deposit analysis (CD IF pattern) for diagnosing lymphocytic enteritis due to CD.
Two-hundred and five patients (144 females) who underwent duodenal biopsy for clinical suspicion of CD and positive celiac genetics were prospectively included. Fifty had villous atrophy, 70 lymphocytic enteritis, and 85 normal histology. Eight patients with non-celiac atrophy and 15 with lymphocytic enteritis secondary to Helicobacter pylori acted as control group. Duodenal biopsies were obtained to assess both CD IEL flow cytometric (complete or incomplete) and IF patterns.
Sensitivity of IF, and complete and incomplete cytometric patterns for CD diagnosis in patients with positive serology (Marsh 1+3) was 92%, 85 and 97% respectively, but only the complete cytometric pattern had 100% specificity. Twelve seropositive and 8 seronegative Marsh 1 patients had a CD diagnosis at inclusion or after gluten free-diet, respectively. CD cytometric pattern showed a better diagnostic performance than both IF pattern and serology for CD diagnosis in lymphocytic enteritis at baseline (95% vs 60% vs 60%, p = 0.039).
Analysis of the IEL flow cytometric pattern is a fast, accurate method for identifying CD in the initial diagnostic biopsy of patients presenting with lymphocytic enteritis, even in seronegative patients, and seems to be better than anti-TG2 intestinal deposits.