Hadi Hossein-Nataj; Mohsen Masjedi; Mohammad Hassan Emami; Mojgan Mokhtari; Fereshteh Alsahebfosoul
Abstract
Background: Increased number of intestinal intraepithelial lymphocytes (IELs) is a key histological finding in the diagnosis of celiac disease (CD); however, the number of IELs in celiac patients and healthy subjects may vary from one region to another. Additionally, there are some seronegative celiac ...
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Background: Increased number of intestinal intraepithelial lymphocytes (IELs) is a key histological finding in the diagnosis of celiac disease (CD); however, the number of IELs in celiac patients and healthy subjects may vary from one region to another. Additionally, there are some seronegative celiac patients with a borderline histology. Objective: To determine the number of the CD3+ and CD8+ IELs T-cells in the celiac patients and healthy subjects (controls) in Isfahan. Methods: The duodenal biopsies were obtained from the celiac patients (n=15) and the controls (n=19). The total number of IELs/100 epithelial cells (ECs) were counted using the hematoxylin-eosin (H&E) staining method, and that of CD3+ and CD8+ IELs/100 ECs were counted using the immunohistochemistry (IHC) staining method. Results: This study defined the upper normal limit for each variable as mean + 2SD. Accordingly, the upper normal limits of the total IELs, CD3+ IELs, and CD8+ IELs/100 ECs were calculated as 37 (95% confidence intervals, CI: 33–41), 22 (95% CI: 19–25) and 12 (95% CI: 10–14), respectively. In 3 clinically CD diagnoses, the total IELs counts/100 ECs were below the upper normal limit, and the histopathological and serologic assays were negative. Nevertheless, the CD8+ IELs T-cells counts/100 ECs showed borderline values. Interestingly, these patients responded to a gluten-free diet (GFD). Conclusions: The study findings suggest that in the clinically diagnosed celiac disease, IELs count/100 ECs below the upper normal limit as well as negative histopathological and serologic assays and the cell density counts of the CD8+ IELs T-cells/100 ECs could be a useful parameter for CD diagnosis and make a decision to put them on a GFD.
Marco Di Tola; Mariacatia Marino; Rossella Casale; Marta Puzzono; Caterina Urciuoli; Antonio Picarelli
Volume 12, Issue 1 , March 2015, , Pages 74-80
Abstract
Background: Celiac disease is a common autoimmune disorder that is diagnosed based on clinical case identification, serological screening, and duodenal histology. However, the existence of mild clinical forms, such as seronegative cases with patchy atrophy and potential celiac disease, can make it difficult ...
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Background: Celiac disease is a common autoimmune disorder that is diagnosed based on clinical case identification, serological screening, and duodenal histology. However, the existence of mild clinical forms, such as seronegative cases with patchy atrophy and potential celiac disease, can make it difficult to determine a definitive diagnosis. The seronegative patients with celiac disease can include those with discordant antibody results and false-negative results, due to unknown origins or selective IgA deficiency. Case presentation: We present two cases with discordant antibody results in order to evaluate if the simultaneous detection of specific antibodies can improve the serodiagnosis of celiac disease. In both patients, the simultaneous detection of IgA/IgG anti-tissue transglutaminase/deamidated gliadin peptides gave discordant positive results by the same antibodies assayed individually. Conclusion: Although further studies are needed to confirm and extend our findings, the simultaneous detection of specific antibodies seems to improve the serodiagnosis of celiac disease in patients with discordant antibody results.