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The Absence of a Mucosal Lesion on Standard Histological Examination Does Not Exclude Diagnosis of Celiac Disease

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Abstract

Some patients with undiagnosed celiac disease have minor mucosal lesions that may not be apparent during routine histological analysis. Twenty-five such patients of our institution were discharged to their primary-care physicians despite having positive endomysial antibody serology. To re-evaluate diagnosis for these patients, immunohistological staining with antibodies to CD2, CD3, CD7, CD8, CD69, and Ki67 was conducted on original biopsies from twenty patients. Clinical, serological, and histological investigations were offered to all fourteen patients who attended for review. We observed a significantly greater (P < 0.0001) numbers of intraepithelial lymphocytes and Ki67-positive enterocytes in sections from these twenty patients than for normal controls. Of the fourteen patients who attended for further review, firm diagnosis of celiac disease was made for seven patients and diagnosis was likely for another two. Our study clearly revealed that over-reliance on standard histological findings results in failure to diagnose celiac disease.

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Acknowledgements

During this study, B. Mohamed was supported by a grant from the Ministry of Scientific Research, Libya. The authors would like to thank Dr J. Jackson and Caroline Liddy for scientific support. We would also like to acknowledge the Department of Histopathology, St. James’s Hospital, Dublin, Ireland.

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Authors and Affiliations

  1. Department of Immunology, St. James’s Hospital and Trinity College Dublin, Dublin, 8, Ireland

    Bashir M. Mohamed, Conleth Feighery, Christian Coates, Una O’Shea & Mohamed Abuzakouk

  2. Department of Histopathology, St. James’s Hospital and Trinity College Dublin, Dublin, 8, Ireland

    Seán O’Briain

  3. Dublin Institute of Molecular Medicine Dublin, Dublin, 8, Ireland

    Bashir M. Mohamed, Conleth Feighery, Christian Coates, Una O’Shea & Mohamed Abuzakouk

  4. Dublin Institute of Technology, Dublin, Ireland

    Jacinta Kelly

  5. Department of Histopathology, St. James’s Hospital, Dublin, 8, Ireland

    David Delaney

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  1. Bashir M. Mohamed
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  2. Conleth Feighery
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  8. Mohamed Abuzakouk
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Correspondence to Conleth Feighery.

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Mohamed, B.M., Feighery, C., Coates, C. et al. The Absence of a Mucosal Lesion on Standard Histological Examination Does Not Exclude Diagnosis of Celiac Disease. Dig Dis Sci 53, 52–61 (2008). https://doi.org/10.1007/s10620-007-9821-5

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  • DOI: https://doi.org/10.1007/s10620-007-9821-5

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