Studies of the rectal mucosa in coeliac sprue: the intraepithelial lymphocyte.

Austin, Linda Lee; Dobbins, William O.

doi:10.1136/gut.29.2.200

Cited by 38 publications

(13 citation statements)

References 9 publications

(1 reference statement)

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“…In a retrospective review of rectal biopsy specimens, significant inflammatory changes were shown in about a third of such cases 10. In more recent years, a series of prospective studies has been conducted by Ensari and colleagues,3 4 which have significantly contributed to the definitive demonstration of gluten dependent inflammatory changes in the rectum of coeliac patients.…”

Section: Discussionmentioning

confidence: 99%

“…15 In this regard, first degree relatives of coeliac patients represent a special population. We have recently performed rectal gluten challenge in siblings of coeliac children,10 and it was clear that two subgroups were present in such a population, about half of them behaving as coeliacs. The data now provided by in vitro challenge of rectal mucosae with gliadin are consistent with the hypothesis that a significant proportion of first degree relatives are sensitised to gliadin.…”

Section: Discussionmentioning

confidence: 99%

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Gliadin activates mucosal cell mediated immunity in cultured rectal mucosa from coeliac patients and a subset of their siblings

Troncone

Mazzarella

Léone

et al. 1998

Gut

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Background-CD3 and cells in the rectal mucosa increase after local instillation of gluten in children with coeliac disease and in half of their siblings. Aim-To establish an in vitro system for assessing immunological changes induced by gluten in the rectum. Patients and Methods-Rectal biopsy specimens obtained from 13 treated coeliac children, nine of their siblings, and nine controls were cultured in vitro with a peptic-tryptic digest of gliadin or ovalbumin. CD3 and CD25 cells were counted, and the expression of adhesion molecules evaluated. Results-In the lamina propria of coeliac biopsy samples cultured with gliadin, but not in those from controls, the expression of vascular cell adhesion molecule 1 (VCAM-1) was enhanced, and the number of CD25 cells was significantly higher than in those cultured in medium alone; the density of intraepithelial CD3 cells was also significantly higher. No diVerences were noted in coeliac biopsy specimens cultured with ovalbumin. A discriminant analysis allowed correct classification of all controls and all coeliacs but one, but three of nine siblings were allocated to the coeliac group. Conclusions-Our data confirm that gliadin is able to activate cell mediated immunity in the rectal mucosa in coeliac patients and in a subset of their first degree relatives. (Gut 1998;43:484-489)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gliadin activates mucosal cell mediated immunity in cultured rectal mucosa from coeliac patients and a subset of their siblings

Troncone

Mazzarella

Léone

et al. 1998

Gut

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“…Using four fields for cell counting at ×200 magnification gave coefficients of variability of 7.2%, 6.8% and 6.9% for entero‐endocrine cells, lamina propria T lymphocytes and mast cells, respectively ( n = 10 biopsies). Intra‐epithelial lymphocytes were counted per 500 epithelial cells as described previously 21 . Surface intra‐epithelial lymphocytes were counted between crypts and crypt intra‐epithelial lymphocytes were counted within longitudinal crypts spanning the full mucosal thickness.…”

Section: Methods Of Cell Countingmentioning

confidence: 99%

Randomized, double‐blind, placebo‐controlled trial of prednisolone in post‐infectious irritable bowel syndrome

Dunlop¹,

Jenkins²,

Neal³

et al. 2003

Aliment Pharmacol Ther

157

120

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Summary Background : Post‐infectious irritable bowel syndrome is associated with increased serotonin‐containing enterochromaffin cells and lymphocytes in rectal biopsies. Animal studies have suggested that steroids reduce the lymphocyte response and suppress some of the post‐infectious changes in neuromuscular function. Aim : To evaluate whether steroids reduce the number of enterochromaffin cells and improve the symptoms of post‐infectious irritable bowel syndrome. Methods : Twenty‐nine patients with post‐infectious irritable bowel syndrome underwent a randomized, double‐blind, placebo‐controlled trial of 3 weeks of oral prednisolone, 30 mg/day. Mucosal enterochromaffin cells, T lymphocytes and mast cells were assessed in rectal biopsies before and after treatment, and bowel symptoms were recorded in a daily diary. Results: Initial enterochromaffin cell counts were increased and correlated with initial lamina propria T‐lymphocyte counts (r = 0.460, P = 0.014). Enterochromaffin cell counts did not change significantly after either prednisolone (− 0.8% ± 9.2%) or placebo (7.9% ± 7.9%) (P = 0.5). Although lamina propria T‐lymphocyte counts decreased significantly after prednisolone (22.0% ± 5.6%, P = 0.003), but not after placebo (11.5% ± 8.6%, P = 0.1), this was not associated with any significant treatment‐related improvement in abdominal pain, diarrhoea, frequency or urgency. Conclusions : Prednisolone does not appear to reduce the number of enterochromaffin cells or cause an improvement in symptoms in post‐infectious irritable bowel syndrome. Other approaches to this persistent condition are indicated.

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“…Two sites are of particular interest: the mouth as the first part of the gastrointestinal tract, and the rectum at its end. In fact, rectal gluten challenges have previously been performed [11–15], but the mouth has never been used as an area of immunological testing. In their extensive studies on the rectal mucosa, Loft and co‐workers showed a primary response to local gluten challenge with a rapid increase in lamina propria volume and a dramatic decline in the number of granulated mast cells.…”

Section: Introductionmentioning

confidence: 99%

Local challenge of oral mucosa with gliadin in patients with coeliac disease

Lähteenoja

Mäki²,

Viander

et al. 2000

Clinical and Experimental Immunology

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In coeliac disease, gluten‐containing diet challenges over many years are sometimes required for diagnosis, especially if the initial diagnosis was equivocal. The rectal gluten challenge has been proposed to simplify coeliac disease diagnosis. We were interested in studying whether the oral mucosa could be used for local challenge with gliadin as an aid in finalizing the diagnosis of coeliac disease. The study groups consisted of 37 treated coeliac disease patients and 10 controls. The challenges on the oral mucosa were performed either supramucosally with gliadin powder (coeliac disease patients) or by submucosal injection of dissolved gliadin (10 μg/ml) (coeliac disease patients and controls). A control challenge with submucosal gliadin solvent was made in the coeliac disease patients. B and T cells, mast cells and T cell subsets were counted and HLA‐DR expression was determined. Biopsies were taken from each provoked area 24 h post‐challenge. A significant increase in the number of CD4+ lymphocytes in the lamina propria (observed in 27/37 patients), but a decrease in the number of mast cells was observed in treated coeliac disease patients after submucosal challenge with gliadin. Following supramucosal challenge with gliadin the counts of intraepithelial CD4+ (in 25/37 patients) and CD8+ T cells (in 27/37 patients) increased significantly and the number of CD4+ T cells in the lamina propria was also significantly increased. Control subjects were tested by submucosal gliadin challenge and no significant changes in the number of cells were observed. HLA‐DR expression did not show increased positivity in coeliac disease patients on submucosal challenge. For the first time the oral mucosa has been used for immunological testing and shown to react to gliadin challenge in coeliac disease patients. Recruitment of T cells upon submucosal gliadin challenge occurred towards the lamina propria, whereas it occurred towards the epithelium in supramucosal gliadin challenge. The numbers of T cells increased in the lamina propria after submucosal challenge. The results suggest that local oral challenge with gliadin may be used as a diagnostic method in coeliac disease; however, further studies in untreated coeliac disease patients are needed to evaluate the usefulness of this method.

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Studies of the rectal mucosa in coeliac sprue: the intraepithelial lymphocyte.

Cited by 38 publications

References 9 publications

Gliadin activates mucosal cell mediated immunity in cultured rectal mucosa from coeliac patients and a subset of their siblings

Gliadin activates mucosal cell mediated immunity in cultured rectal mucosa from coeliac patients and a subset of their siblings

Randomized, double‐blind, placebo‐controlled trial of prednisolone in post‐infectious irritable bowel syndrome

Local challenge of oral mucosa with gliadin in patients with coeliac disease

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