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Digestive Diseases and Sciences

, Volume 60, Issue 4, pp 1004–1009 | Cite as

Distal Duodenum Versus Duodenal Bulb: Intraepithelial Lymphocytes Have Something to Say in Celiac Disease Diagnosis

  • Ana De Andrés
  • Cristina Camarero
  • Garbiñe Roy
Original Article

Abstract

Background and Aim

After clinical screening and the serological test, many patients still require a duodenal biopsy for celiac disease diagnosis. Mild histological lesions, unspecific findings and patchiness are frequent outcomes of this mandatory diagnostic tool, thus complicating clinical decisions.

Methods

We analyzed the lymphoid components [number of total intraepithelial lymphocytes (IELs), TcR-γδ and CD3IELs] of the duodenal epithelium by flow cytometry in samples obtained from bulb and distal duodenum during upper gastrointestinal endoscopies performed for diagnostic purposes.

Results

IEL counts and IEL subset distribution (IEL lymphogram) remain invariant along duodenal mucosa revealing a specific profile (immunophenotype) that characterizes either a healthy mucosa or a celiac mucosa. The celiac immunophenotype persists regardless of the biopsy’s anatomical location or the corresponding histological findings.

Conclusions

We propose the IEL lymphogram by flow cytometry as an immunological parameter to discern celiac condition from healthy mucosa. This obviates not only misinterpretation of minor histological changes, but also patchiness and the concerns about the location and number of biopsies.

Keywords

Celiac disease Immunophenotype Patchy lesion Flow cytometry 

Abbreviations

CD

Celiac disease

EMA

Endomysial antibodies

GFD

Gluten-free diet

tTG

IgA anti-transglutaminase-2 auto-antibodies

Notes

Acknowledgments

Supported by grant MEC I+D SAF2006-01403 from the Spanish Ministry for Education and Science.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ana De Andrés
    • 1
  • Cristina Camarero
    • 2
  • Garbiñe Roy
    • 1
  1. 1.Department of ImmunologyHospital Universitario Ramón y Cajal de MadridMadridSpain
  2. 2.Department of Paediatric GastroenterologyHospital Universitario Ramón y CajalMadridSpain

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