Detection of Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology in a Population-Based Study

Marjorie M. Walker, Joseph A Murray, Jukka Ronkainen, Pertti Aro, Tom Storskrubb, Mauro D'Amato, Brian Lahr, Nicholas J. Talley, Lars Agreus

Research output: Contribution to journalArticle

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Abstract

Background & Aims: Although serologic analysis is used in diagnosis of celiac disease, histopathology is considered most reliable. We performed a prospective study to determine the clinical, pathologic, and serologic spectrum of celiac disease in a general population (Kalixanda study). Methods: A random sample of an adult general population (n = 1000) was analyzed by upper endoscopy, duodenal biopsy, and serologic analysis of tissue transglutaminase (tTg) levels; endomysial antibody (EMA) levels were analyzed in samples that were tTg+. The cut off values for diagnosis of celiac disease were villous atrophy with 40 intraepithelial lymphocytes (IELs)/100 enterocytes (ECs). Results: Samples from 33 subjects were tTg+, and 16 were EMA+. Histologic analysis identified 7 of 1000 subjects (0.7%) with celiac disease; all were tTg+, and 6 of 7 were EMA+. Another 26 subjects were tTg+ (7/26 EMA+). This was addressed by a second quantitative pathology study (nested case control design) using a threshold of 25 IELS/100 ECs. In this analysis, all 13 samples that were tTg+ and EMA+ had ≥25 IELs/100 ECs. In total, 16 subjects (1.6%) had serologic and histologic evidence of gluten-sensitive enteropathy. IELs were quantified in duodenal biopsy samples from seronegative individuals (n = 500); 19 (3.8%) had >25 IELs and lymphocytic duodenosis. Conclusions: Measurement of ≥25 IELs/100 ECs correlated with serologic indicators of celiac disease; a higher IEL threshold could miss 50% of cases. Quantification of tTg is a sensitive test for celiac disease; diagnosis can be confirmed by observation of ≥25 IELs/100ECs in duodenal biopsy specimens. Lymphocytic enteropathy (celiac disease and lymphocytic duodenosis) is common in the population (5.4%).

Original languageEnglish (US)
Pages (from-to)112-119
Number of pages8
JournalGastroenterology
Volume139
Issue number1
DOIs
StatePublished - Jul 2010

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Celiac Disease
Serology
Lymphocytes
Enterocytes
Population
Antibodies
Biopsy
transglutaminase 2
Endoscopy
Atrophy
Case-Control Studies
Observation
Prospective Studies
Pathology

Keywords

  • Celiac Disease
  • Epidemiology
  • Histology
  • Serology

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Detection of Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology in a Population-Based Study. / Walker, Marjorie M.; Murray, Joseph A; Ronkainen, Jukka; Aro, Pertti; Storskrubb, Tom; D'Amato, Mauro; Lahr, Brian; Talley, Nicholas J.; Agreus, Lars.

In: Gastroenterology, Vol. 139, No. 1, 07.2010, p. 112-119.

Research output: Contribution to journalArticle

Walker, MM, Murray, JA, Ronkainen, J, Aro, P, Storskrubb, T, D'Amato, M, Lahr, B, Talley, NJ & Agreus, L 2010, 'Detection of Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology in a Population-Based Study', Gastroenterology, vol. 139, no. 1, pp. 112-119. https://doi.org/10.1053/j.gastro.2010.04.007
Walker, Marjorie M. ; Murray, Joseph A ; Ronkainen, Jukka ; Aro, Pertti ; Storskrubb, Tom ; D'Amato, Mauro ; Lahr, Brian ; Talley, Nicholas J. ; Agreus, Lars. / Detection of Celiac Disease and Lymphocytic Enteropathy by Parallel Serology and Histopathology in a Population-Based Study. In: Gastroenterology. 2010 ; Vol. 139, No. 1. pp. 112-119.
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