New tools for the Diagnosis of Celiac Disease

Bañares, Fernando Fernández; Farré, Carme; Carrasco, Anna; Mariné, Meritxell; Esteve, María

doi:10.3926/oms.255

Cited by 2 publications

(2 citation statements)

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“…Several new diagnostic tools can be used for the diagnosis of coeliac disease in doubtful cases . Immunological studies assessing intraepithelial lymphocyte subpopulations by flow cytometry in fresh mucosal duodenal samples have described a coeliac intraepithelial lymphogram, defined as an increase in CD3 + T‐cell receptor gamma delta + (TCRγδ + ) intraepithelial lymphocytes (IEL) plus a concomitant decrease in CD3 − cells, which seems to be highly accurate for coeliac disease diagnosis .…”

Section: Introductionmentioning

confidence: 99%

Gamma delta⁺ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy

Fernández‐Bañares

Crespo

Núñez

et al. 2020

Aliment Pharmacol Ther

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Summary Background The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. Aim To evaluate the accuracy of both an increase in CD3+ T‐cell receptor gamma delta+ (TCRγδ+) intraepithelial lymphocytes and coeliac lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. Methods Sixty‐seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3− by flow cytometry were performed at the index endoscopy. Coeliac lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3− intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. Results Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA‐DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b‐c; P = 0.055), as compared to noncoeliac ones. Coeliac lymphogram was associated with a sensitivity of 87% (CI, 73.7‐95) and specificity of 96.7% (82.7‐99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2‐97.6) and specificity of 83.3% (65.3‐94.3). Among patients with a pre‐test coeliac disease probability of 30%, post‐test probabilities were 92% and 5% for positive and negative coeliac lymphogram, and 70% and 4% for positive and negative TCRγδ+. Conclusions Coeliac lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.

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Section: Introductionmentioning

confidence: 99%

Gamma delta⁺ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy

Fernández‐Bañares

Crespo

Núñez

et al. 2020

Aliment Pharmacol Ther

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“…Other diagnostic approaches beyond conventional histology and serology have been introduced for the diagnosis of CD [11]. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for the Study of Coeliac Disease (ESsCD) guidelines suggest that in doubtful cases, a high CD3 + T-cell receptor gamma delta + (TCRγδ + ) intraepithelial lymphocyte (IEL) count increases the likelihood of CD diagnosis [4,5].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis: Accuracy of Both Gamma Delta+ Intraepithelial Lymphocytes and Coeliac Lymphogram Evaluated by Flow Cytometry for Coeliac Disease Diagnosis

2019

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It has been suggested that in doubtful cases of coeliac disease, a high CD3 + T-cell receptor gamma delta + (TCRγδ + ) intraepithelial lymphocyte count increases the likelihood of coeliac disease. Aim: To evaluate the diagnostic accuracy of both an isolated increase of TCRγδ + cells and a coeliac lymphogram (increase of TCRγδ + plus decrease of CD3 − intraepithelial lymphocytes) evaluated by flow cytometry in the diagnosis of coeliac disease. Methods: The literature search was conducted in MEDLINE and EMBASE. The inclusion criteria were: an article that allows for the construction of a 2 × 2 table of true and false positive and true and false negative values. A diagnostic accuracy test meta-analysis was performed. Results: The search provided 49 relevant citations, of which 6 were selected for the analysis, which represented 519 patients and 440 controls. Coeliac lymphogram: The pooled S and Sp were 93% and 98%, without heterogeneity. The area under the SROC curve (AUC) was 0.98 (95% CI, 0.97-0.99). TCRγδ + : Pooled S and Sp were both 95%, with significant heterogeneity. The AUC was 0.97 (95% CI, 0.95-0.98). Conclusions: Both TCRγδ + count and coeliac lymphogram assessed by flow cytometry in duodenal mucosal samples are associated with a high level of diagnostic accuracy for and against coeliac disease.In addition, the overlap between patients with non-coeliac gluten sensitivity and CD patients with a Marsh type I lesion becomes evident and makes differential diagnosis quite difficult [9,10]. Increasingly, clinicians face the challenge of making a diagnosis of patients who choose to live without gluten, without a previous diagnosis of CD. This is challenging, since both the serology and histology of the small intestine are normalized in patients with CD on a gluten-free diet (GFD). In these circumstances, HLA genotyping is of value, since CD is extremely improbable in patients who are HLA-DQ2/8 negative, though it is insufficient in HLA-DQ2/8 positive patients, since 30-40% of the healthy population are also positive.Other diagnostic approaches beyond conventional histology and serology have been introduced for the diagnosis of CD [11]. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for the Study of Coeliac Disease (ESsCD) guidelines suggest that in doubtful cases, a high CD3 + T-cell receptor gamma delta + (TCRγδ + ) intraepithelial lymphocyte (IEL) count increases the likelihood of CD diagnosis [4,5]. IELs are increased in the mucosa of untreated coeliac patients. In general, these IELs are CD3 + αβ + T-cell-receptor-bearing cells. However, 20-30% of CD3 + IELS are γδ + T-cell-receptor-bearing cells in CD, which comprise fewer than 10% of the IELs in non-coeliac subjects [12]. TCRγδ + IELs are considered to be highly sensitive and specific for CD, and, furthermore, remain elevated despite a GFD [13][14][15]. Non-T-cell CD3 − IELs are the second most abundant IEL subset in healthy mucosa. CD3 − IELs comprise heterogeneous phenotypes, of which the...

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New tools for the Diagnosis of Celiac Disease

Cited by 2 publications

References 42 publications

Gamma delta⁺ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy

Gamma delta⁺ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy

Systematic Review and Meta-Analysis: Accuracy of Both Gamma Delta+ Intraepithelial Lymphocytes and Coeliac Lymphogram Evaluated by Flow Cytometry for Coeliac Disease Diagnosis

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New tools for the Diagnosis of Celiac Disease

Cited by 2 publications

References 42 publications

Gamma delta+ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy

Gamma delta+ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy

Systematic Review and Meta-Analysis: Accuracy of Both Gamma Delta+ Intraepithelial Lymphocytes and Coeliac Lymphogram Evaluated by Flow Cytometry for Coeliac Disease Diagnosis

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Gamma delta⁺ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy

Gamma delta⁺ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy