Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 139; no. 1; p. 112
• Main Authors: Walker, Marjorie M, Murray, Joseph A, Ronkainen, Jukka, Aro, Pertti, Storskrubb, Tom, D'Amato, Mauro, Lahr, Brian, Talley, Nicholas J, Agreus, Lars
• Format: Journal Article
• Language: English
• Published: United States 2010
• Subjects: Adult; Aged; Aged, 80 and over; Case-Control Studies; Celiac Disease - diagnosis; Celiac Disease - pathology; Duodenum - pathology; Female; HLA-DQ Antigens - genetics; Humans; Male; Middle Aged; Prospective Studies; Serologic Tests
• DOI: 10.1053/j.gastro.2010.04.007

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). 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). 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 > or =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. Measurement of > or =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 > or =25 IELs/100ECs in duodenal biopsy specimens. Lymphocytic enteropathy (celiac disease and lymphocytic duodenosis) is common in the population (5.4%).