Fernando Fernández-Bañares1,2, Laura Crespo3, Concepción Núñez4, Natalia López-Palacios5, Eva Tristán1,2, Santiago Vivas6, Sergio Farrais7, Beatriz Arau1,2, Judith Vidal8, Garbiñe Roy9, Maria Esteve1,2. 1. Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Terrassa, Spain. 2. Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Madrid, Spain. 3. Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 4. Laboratorio de investigación en Genética de enfermedades complejas, Hospital Clínico San Carlos, IdISSC, Madrid, Spain. 5. Department of Gastroenterology, Hospital Clínico San Carlos, IdISSC, Madrid, Spain. 6. Department of Gastroenterology, Complejo Asistencial Universitario de León, León, Spain. 7. Department of Gastroenterology, Hospital Fundación Jiménez Díaz, Madrid, Spain. 8. Department of flow cytometry. CATLAB, Viladecavalls, Spain. 9. Department of Immunology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Abstract
BACKGROUND: The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. AIM: To evaluate the accuracy of both an increase in CD3+ T-cell receptor gamma delta+ (TCRγδ+ ) intraepithelial lymphocytes and coeliac lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. METHODS: Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3- by flow cytometry were performed at the index endoscopy. Coeliac lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3- intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. RESULTS: Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac lymphogram, and 70% and 4% for positive and negative TCRγδ+ . CONCLUSIONS: Coeliac lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.
BACKGROUND: The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. AIM: To evaluate the accuracy of both an increase in CD3+ T-cell receptor gamma delta+ (TCRγδ+ ) intraepithelial lymphocytes and coeliac lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. METHODS: Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3- by flow cytometry were performed at the index endoscopy. Coeliac lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3- intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. RESULTS: Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac lymphogram, and 70% and 4% for positive and negative TCRγδ+ . CONCLUSIONS: Coeliac lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.
Authors: Annalisa Schiepatti; Anupam Rej; Stiliano Maimaris; Simon S Cross; Petra Porta; Imran Aziz; Tim Key; John Goodwin; Amelie Therrien; Shakira Yoosuf; Daniel A Leffler; Jocelyn A Silvester; Catherine Klersy; Federico Biagi; David S Sanders Journal: Aliment Pharmacol Ther Date: 2021-09-08 Impact factor: 8.171
Authors: Cristina Camarero; Ana De Andrés; Carlota García-Hoz; Belén Roldán; Alfonso Muriel; Francisco León; Garbiñe Roy Journal: Clin Transl Gastroenterol Date: 2021-11-10 Impact factor: 4.488
Authors: Annalisa Schiepatti; David S Sanders; Paola Baiardi; Giacomo Caio; Carolina Ciacci; Katri Kaukinen; Benjamin Lebwohl; Daniel Leffler; Georgia Malamut; Joseph A Murray; Kamran Rostami; Alberto Rubio-Tapia; Umberto Volta; Federico Biagi Journal: Gut Date: 2022-06-08 Impact factor: 31.793
Authors: Fernando Fernández-Bañares; Beatriz Arau; Agnès Raga; Montserrat Aceituno; Eva Tristán; Anna Carrasco; Laura Ruiz; Albert Martín-Cardona; Pablo Ruiz-Ramírez; Maria Esteve Journal: Nutrients Date: 2021-05-26 Impact factor: 5.717