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.
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).
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%.
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.
[Show abstract][Hide abstract] ABSTRACT: Dit proefschrift geeft een gedetailleerd overzicht van het management van gecompliceerde vormen van coeliakie, met name refractaire coeliakie, met de huidige onderverdeling in twee categorieën (RCD type I en II), en enteropathie geassocieerd T-cel lymfoom (EATL).
[Show abstract][Hide abstract] ABSTRACT: Gluten enteropathy, widely known as celiac sprue, is an old disease as its basic clinical and pathogenetic features where established 50 years ago. Recently mounting new data have come to light concerning multiple aspects of this dis-order. The previously rare clinical entity that presented with a severe chronic diarrheal syndrome following the conges-tion of certain cereals has changed to a common autoim-mune related disease with various manifestations, genetic background and new modes of diagnosis and possible treat-ment. The contemporary gastroenterologist needs to be aware of all the new tips and tricks which will guide his thoughts in suspecting celiac disease and be able to recog-nize it promptly and reliably. This is clearly important as gluten enteropathy proves itself to be a treatable disease but with insidious and devastating complications if left untreated. In this review an effort has been made to encom-pass all the recently acquired knowledge concerning the clinical presentation, serologic detection, endoscopic signs, histologic findings and treatment of celiac disease.
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