Time trend occurrence of duodenal intraepithelial lymphocytosis and celiac disease in an open access endoscopic population

Abstract

Background: Duodenal intraepithelial lymphocytosis (DIL) is a histological finding characterized by the increase of intraepithelial CD3T-lymphocytes over the normal value without villous atrophy, mostly associated to coeliac disease (CD), Helicobacter pylori (Hp) gastritis and autoimmune diseases. Objective: To assess the occurrence of DIL, CD and Hp gastritis in an endoscopic population over a 13 year period. Methods: From 2003 to 2015 we included adult patients who consecutively underwent oesophago-gastro-duodenoscopy (OGD) with duodenal biopsies assessing the overall and annual occurrence of DIL and CD and the prevalence of Hp gastritis. Results: 160 (2.3%) patients with DIL and 275 (3.9%) with CD were detected among 7001 patients. CD occurrence was higher from 2003 to 2011, while since 2012 DIL occurrence gradually increased significantly compared to CD (p ¼ 0.03). DIL patients were more frequently female (p ¼ 0.0006) and underwent OGD more frequently for dyspepsia (p ¼ 0.002) and for indications not related to gastrointestinal symptoms than CD patients (p ¼ 0.0003). Hp gastritis occurred similarly in CD and DIL patients but the latter had higher frequency of atrophic body gastritis (p ¼ 0.005). Conclusions: DIL is a condition increasing in the general endoscopic population mainly diagnosed by chance. Concomitant gastric histological evaluation is able in one third of DIL patients to identify associated possible causes of DIL, such as Hp and atrophic gastritis.

Duodenal Histological Findings and Risk of Coeliac Disease in Subjects with Autoimmune Atrophic Gastritis: A Retrospective Evaluation

“…This is probably because the guidelines provide a strict endoscopic follow-up every 2–3 years [31], whereas for CeD there is no indication to repeat endoscopy, unless in the presence of onset or persistent symptoms [32]. Compared to previous literature, our results are similar to those described by Kalkan and Soykan [17] who identified 11 patients with CeD amongst 320 patients with AAG (3.4%) and higher than those of Galli et al [33] who described only 2 cases with histological evidence of AAG amongst 245 subjects with a new diagnosis of CeD. Therefore, evidence regarding the possible association with CeD has accumulated in recent years, but prospective studies are needed to confirm this hypothesis [1].…”

Relationship between Persistent Gastrointestinal Symptoms and Duodenal Histological Findings after Adequate Gluten-Free Diet: A Gray Area of Celiac Disease Management in Adult Patients

“…Nevertheless, more recent studies have demonstrated the role of mast cells in GI functional disorders, such as IBS or functional dyspepsia, and the lack of their reduction after the beginning of a GFD [ 46 ]. In addition, some studies reported histological changes in the celiac stomach potentially responsible for the important prevalence of dyspepsia in CD patients at the time of diagnosis [ 46 , 47 , 48 , 49 ]. Although H.p.…”

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

“…For this reason, it is viewed as a quite common condition with an increasing trend over time. Galli et al [ 8 ] found the prevalence of ME to be 6.2% in a retrospective database of 7000 duodenal biopsy samples and, interestingly, reported a fivefold increase from 2010 to 2013, especially for non-gluten related disorders. Another two studies reported a prevalence of ME of 1.3% and 2.2%, respectively [ 9 , 10 ].…”