Efficacy of the intraepithelial lymphogram in the diagnosis of celiac disease

PEZZARINI, E; BASIGLIO, CL; HERNANDEZ, MA; PRETTO, LE; LOPEZ ANDREOLI, C; NIERI, P; CORBO, ML; RODIL, A; BESSONE, F; PELUSA, HF

CABA

Congreso; Reunión Anual de la Sociedad Argentina de Fisiología (SAFIS); 2023

SAFIS

Introduction: Celiac disease (CD) is a chronic autoimmune systemic disorder induced by the intake of gluten protein contained in wheat, oat, barley and rye in genetically predisposed individuals [HLA DQ2(+) and/or DQ8(+)] and is characterized by the presence of antibodies and proximal small intestine mucosal injury: villous atrophy, crypt hyperplasia, and increase in intraepithelial lymphocytes (IEL). The IEL pattern is relevant as a marker of CD; an intraepithelial lymphogram (IL) presents a celiac pattern (CP, present in 95% of the patients) when an increase in total IEL, an increase in TCRgd+ subpopulation and an almost complete disappearance of the CD3-/CD103+ subpopulation are found. Objectives: To evaluate the utility of IL in the diagnosis of CD. Methods: Patients attending the Gastroenterology Service of the Hospital Provincial del Centenario, who had signed the informed concern were included in the study. Control Group (CG): patients subjected to upper endoscopy, in whom CD had been ruled out by clinical and serological criteria and whose intestinal biopsy at the time of the study was 0-2 (Marsh-Oberhuber classification, n=21). Study group (SG): patients positive for clinical and/or serological markers of CD and whose intestinal biopsy at the time of the study was compatible with CD (grade≥3, Marsh-Oberhuber classification, n=11) or patients with confirmed diagnosis of CD and under a gluten-free diet, subjected to control intestinal biopsy (n=5). Flow cytometric analysis of IEL subpopulations was performed in an intestinal biopsy sample and the presence of a CP was assessed. Results: None of the patients in the CG present CP; 15 patients of the SG presented a CP and 1 did not. Sensitivity (Se) and specificity (Sp) of IL for CD diagnosis were 94% and 100% respectively; positive predictive value (PPV) and negative predictive value (NPV) were 100% and 95%, respectively. Conclusion: The elevated Se and Sp of IL, together with its high PPV, allow us to postulate that applying the IL to the current diagnostic process would provide the clinician with an alternative algorithm in cases of unclear clinical manifestations and discrepancy with other markers of CD.