Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice

Rostami, Kamran; Kerckhaert, J.; Tiemessen, R.; Blomberg, B. Mary E. von; Meijer, Jos W. R.; Mulder, Chris J.

doi:10.1016/s0002-9270(99)00038-6

Cited by 135 publications

(153 citation statements)

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“…The histologic changes in biopsies from such patients are not sufficient to make the diagnosis of celiac disease according to the established criteria 37 and the interpretation of these biopsies is further compounded by the fact that serologic tests are often negative at this stage. 38,39 Mino and Lauwers, 13 presumably, also used a cutoff of 20 lymphocytes/ 100 epithelial cells for similar reasons. If we use 25 lymphocytes/100 epithelial cells as the upper limit of normal, an increased number of intraepithelial lymphocytes would still be seen in a substantial number (28%) of duodenal biopsies from patients with H. pylori gastritis (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

et al. 2005

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We have observed expansions of intraepithelial lymphocytes in duodenal biopsies from patients with Helicobacter pylori gastritis. This study was undertaken to prospectively evaluate, unselected, paired gastric and duodenal biopsies from 50 patients with H. pylori gastritis and a comparison group of 30 patients with other types of gastritis (10 autoimmune and 20 reactive) to: (1) quantify duodenal intraepithelial lymphocytes, determine their distribution patterns, epithelial location, and phenotype, and (2) correlate the intraepithelial lymphocyte elevations with various features of gastric and duodenal pathology. Intraepithelial lymphocytes were analyzed with antibodies including CD3, CD8, and TIA-1. A stain for H. pylori was performed on all gastric and duodenal biopsies. Duodenal intraepithelial lymphocytes from patients with H. pylori gastritis (using CD3) ranged from 3 to 42 lymphocytes/100 epithelial cells (mean 18.5) compared to 3 to 18 lymphocytes/100 epithelial cells (mean 6.6) in the comparison group. Intraepithelial lymphocyte elevations were seen in 44% of the duodenal biopsies from patients with H. pylori gastritis (using CD3). Significant differences in the intraepithelial lymphocyte counts between patients with H. pylori gastritis and the comparison group were seen for all three T-cell antigens (Po0.001 for CD3 and CD8 and Po0.002 for TIA-1). Duodenal intraepithelial lymphocytes in the H. pylori þ cases had a latent cytotoxic phenotype, H. pylori was not visualized in any of the duodenal biopsies from patients with H. pylori gastritis, and no patient had clinical evidence of celiac disease. Our study highlights frequent duodenal intraepithelial lymphocytosis in individuals with H. pylori gastritis and the lymphocyte distribution patterns (and numbers) overlapped with those described for celiac disease patients. H. pylori gastritis must be considered as a possible explanation for duodenal intraepithelial lymphocytosis with normal villous architecture, especially when lymphocytosis is patchy, intraepithelial lymphocytes display a 'latent' cytotoxic phenotype, and the clinical findings and serologic profile does not fit celiac disease.

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Section: Discussionmentioning

confidence: 99%

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

et al. 2005

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“…While serological screening remains a powerful tool in the diagnosis of CD, it has been demonstrated that EMA sensitivity is reduced in cases of partial rather than total villous atrophy (15), and the gold standard for the diagnosis of cluster of differentiation remains the finding of villous atrophy on duodenal biopsy.…”

Section: Introductionmentioning

confidence: 99%

Serological screening for coeliac disease in adults with Turner's syndrome: prevalence and clinical significance of endomysium antibody positivity

Frost¹,

Band²,

Conway³

2009

European Journal of Endocrinology

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Objective: To investigate the prevalence of coeliac disease (CD) in an adult population with Turner's syndrome (TS). Design: A clinic population with TS was screened using a serological test for CD. Methods: Two hundred and fifty six patients with TS were included in the study. Five patients had existing diagnoses of CD. The remaining 251 asymptomatic patients were screened using an IgA endomysium antibody (EMA) test. Positive cases were offered endoscopy with duodenal biopsy. HLA typing was undertaken in existing cases and new EMA-positive cases. Results: Of the 251 patients screened, eight were found to be EMA positive (3.2%). Seven patients proceeded to duodenal biopsy on which all were confirmed histologically to have cluster of differentiation (2.8%). The prevalence of subclinical cluster of differentiation in the population can therefore be estimated between 2.8 and 3.2%. The total population prevalence of CD, including the previously diagnosed cases, is estimated between 4.7 and 5.1%. Ten patients with histologically confirmed cluster of differentiation underwent HLA typing of which eight were HLA-DQ2 positive, one was HLA-DQ8 positive and one was negative to both HLA-DQ2 and HLA-DQ8. Conclusions: This study demonstrates an increased prevalence of cluster of differentiation in an adult population with TS over the general population. This is consistent with previous data published in paediatric populations.

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“…1,2 The disease is characterized by lesions of the small intestine with partial to total villous atrophy, crypt hyperplasia and invasion of lymphocytes into the gut epithelium and lamina propria. 3,4 The main clinical symptoms include chronic diarrhoea and growth retardation, but abdominal pain, anaemia, osteopenia and chronic fatigue may also occur. 5 However, most patients show only some of these symptoms, while others are monosymptomatic or have no symptoms at all.…”

Section: Introductionmentioning

confidence: 99%

Defining the contribution of the HLA region to cis DQ2-positive coeliac disease patients

et al. 2004

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The major genetic susceptibility to coeliac disease is contributed by the human leukocyte antigen (HLA) region. The primary association is with the HLA-DQ2 molecule, encoded by the DQA1*05 and DQB1*02 alleles, which is expressed by over 90% of patients. The aim of our study was to perform an extensive scan of the entire HLA region to determine whether there is evidence for the presence of additional HLA susceptibility genes for coeliac disease in the Dutch population, acting independently of DQ2. In all, 16 microsatellite markers and the DQA1 and DQB1 genes were genotyped in simplex cis DQ2-positive coeliac disease families and cis DQ2-positive control families. Allele frequencies of markers on phase-known DQ2-positive haplotypes transmitted to patients were compared to a combined group of DQ2-positive nontransmitted and control haplotypes, thereby controlling for the DQ2 contribution. No significant differences at any of the marker loci were detected, suggesting that DQ2 is the major HLA risk factor for coeliac disease. Individuals homozygous for DQ2 or heterozygous for DQA1*05-DQB1*02/DQA1*0201-DQB1*02 were found to be at five-fold increased risk for development of coeliac disease (Po10 À8 ). This risk seems to be conferred by the presence of a second DQB1*02 allele next to one DQA1*05-DQB1*02 haplotype, independently of the second DQA1 allele.

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Sensitivity of antiendomysium and antigliadin antibodies in untreated celiac disease: disappointing in clinical practice

Cited by 135 publications

References 0 publications

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

Serological screening for coeliac disease in adults with Turner's syndrome: prevalence and clinical significance of endomysium antibody positivity

Defining the contribution of the HLA region to cis DQ2-positive coeliac disease patients

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