Cellular infiltrate of the jejunum after re-introduction of dietary gluten in children with treated coeliac disease.

Lancaster-Smith, M.; Packer, Sharon; Kumar, Parveen; Harries, J T

doi:10.1136/jcp.29.7.587

Cited by 25 publications

(25 citation statements)

References 10 publications

(28 reference statements)

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“…Changes in Ig-cell populations were shown to persist longer than histological damage in CD. This finding is consistent with some earlier studies [16,17], though it contradicts other reports [12,35].…”

Section: Discussionsupporting

confidence: 77%

“…Sophisticated studies into IEL cell kinetics have shown that absolute IEL counts are even decreased in CD [9,22,23], due to luminopetal migration and loss. Relative IEL counts per number of epithelial cells which is in itself subject to considerable alteration in a fiat mucosa, thus can be a clinical but not a pathogenetic indicator of the enteropathy [4,16,19,24,30]. IEL counts were found to be significantly higher in CD and CMPI compared to controls.…”

Section: Discussionmentioning

confidence: 97%

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Small intestinal mucosa in coeliac disease and cow's milk protein intolerance: Morphometric and immunofluorescent studies

1982

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One hundred and twenty-five small intestinal biopsies from children with coeliac disease (CD), cow's milk protein intolerance (CMPI) and controls were compared by morphometric analysis, by counting intraepithelial lymphocytes (IEL) and by quantitative evaluation of immunoglobulin-containing cells of lamina propria. The double-stain immunofluorescent technique of Brandtzaeg and Baklien [2] was used, based on defined mucosal tissue units. A patchy enteropathy was found in 60% of CMPI, and in 14% of nonspecific changes, but never in CD. There was a significant difference in crypt depth between CD (360 +/- 80 microns) and CMPI (217 +/- 92 microns), even when lesions of equal grade were compared (P less than 0.015). IEL counts per 1000 epithelial cells showed even better discrimination between the groups (CD: 793 +/- 173, CMPI: 320 +/- 143, P less than 0.001). In CD, there was a relatively greater increase of IgM-cells (X 4.9) and of IgG-cells (X 4.2) than of IgA-cells (X 2.6). Ig-cell changes outlasted the morphological lesion in CD on a gluten-free diet. In CMPI, IgM-cells (X 2.3), IgG-cells (X 2.5), and IgA-cells (X 1.7) were proportionately increased, compared to controls. A special increase of IgE-cells in CMPI could not be substantiated. By computerized stepwise discriminant analysis based upon crypt depth, villus/crypt-ratio, IEL-count, and counts of IgM-, IgG-, IgA-containing cells of lamina propria, accurate classification of patient groups was accomplished, even when only the initial biopsy data were analysed.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 97%

Small intestinal mucosa in coeliac disease and cow's milk protein intolerance: Morphometric and immunofluorescent studies

1982

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“…Usually IEL have been counted in relation to a fixed number of epithelial cells (Ferguson and Murray, 1971;Otto, 1973;Lancaster-Smith et al, 1976) or to a fixed length of epithelial layer (Holmes et al, 1974). Accordingly, Ferguson (1977) has proposed that the normal range is between six and 40 IEL per 100 epithelial cells.…”

Section: Discussionmentioning

confidence: 99%

“…This increase has been used both as a diagnostic indicator and to support certain immunological theories of origin of the mucosal lesion (Ferguson and Murray, 1971;Otto, 1973;Holmes et al, 1974;Lancaster-Smith et al, 1976).…”

mentioning

confidence: 99%

Measuring intraepithelial lymphocytes, surface area, and volume of lamina propria in the jejunal mucosa of coeliac patients.

Guix¹,

Skinner²,

Whitehead³

1979

Gut

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SUMMARY An accurate morphometric method is described for quantifying the intraepithelial lymphocytes (IEL), the area of the epithelium, and the volume of the lamina propria in jejunal mucosa of coeliac patients. All measurements are related to a unit-length of muscularis mucosa which is unaltered by the disease process. The results show a significant decrease in the epithelial surface area and an increase in the volume of the lamina propria in coeliacjejunal mucosa compared with normal levels, even after treatment. The number of IEL is the same as normal before or after treatment. Other workers have shown an apparent increase in IEL in untreated disease which returns to normal levels after therapy. This discordance is explained and the importance of accurate quantitative methodology is stressed.The number of intraepithelial lymphocytes (TEL) in the jejunal mucosa of coeliac patients has been measured by several authors who have claimed that they are increased. This increase has been used both as a diagnostic indicator and to support certain immunological theories of origin of the mucosal lesion (Ferguson and Murray, 1971;Otto, 1973;Holmes et al., 1974;Lancaster-Smith et al., 1976 patients were first seen, and both clinical and morphological improvement after a gluten free diet with the appearance of clinical symptoms and morphological abnormalities after further gluten challenge. Biopsies were taken with a Crosby capsule under radiological control from a point just distal to the ligament of Treitz, and all processed for histology, according to the same technique, so that any errors in cell counting introduced by variability of tissue shrinkage and section thickness were minimised. This included timed fixation in buffered formalin (4%) followed by routine paraffin embedding and sectioning on the same microtome, at the same setting of 4 /L. Sections from all the cases were then stained together by haematoxylin and eosin.All biopsies had to include the muscularis mucosa which was used as the unit against which all other measurements were made. A grid (Fig. 1) was placed in the eyepiece of the microscope and counts of different fields were made in each case. According to the 'quotient of accumulative addition of values' (Dunnill 1968), it was demonstrated that seven different fields needed to be counted in each case. Figure 2 shows a typical graph when epithelium and lamina propria are being assessed. It can be seen that after 154 intercepts in the epithelial layer and 94 points on the lamina propria the quotient remains stable and this determines the minimum number of fields which have to be evaluated. The unit-length of muscularis mucosa in each field was 275 on 12 May 2018 by guest. Protected by copyright.

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“…10, 1 1, 15). Quantitative changes in the number of lymphoid cells of the jejunal mucosa of untreated, treated, and glutenchallenged coeliac patients have previously been studied only by light microscopy (2, 4, 6,8,12). On the basis of these findings a number of different immune mechanisms have been suggested for the mucosal lesion (4, 6,12).…”

mentioning

confidence: 96%

Morphometric Electron and Light Microscope Analysis of Lymphoid Cells in Coeliac Disease

Guix¹,

Skinner²,

Whitehead³

1979

Scandinavian Journal of Gastroenterology

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Lymphocytes in jejunal biopsies from normal subjects and from untreated, treated, and gluten-challenged coeliac patients were examined by accurate morphometric methods. There was no significant difference between lymphocytes from different sources and those in the jejunum. Transforming lymphocytes were ultrastructurally quite different from non-transforming lymphocytes. The appearance of transforming lymphocytes in the lamina propria in different groups of coeliac patients is in accordance with the increase in the number of plasma cells. In treated patients the results indicate a rapid humoral response to gluten challenge.

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Cellular infiltrate of the jejunum after re-introduction of dietary gluten in children with treated coeliac disease.

Cited by 25 publications

References 10 publications

Small intestinal mucosa in coeliac disease and cow's milk protein intolerance: Morphometric and immunofluorescent studies

Small intestinal mucosa in coeliac disease and cow's milk protein intolerance: Morphometric and immunofluorescent studies

Measuring intraepithelial lymphocytes, surface area, and volume of lamina propria in the jejunal mucosa of coeliac patients.

Morphometric Electron and Light Microscope Analysis of Lymphoid Cells in Coeliac Disease

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