PMID- 26140001
OWN - NLM
STAT- MEDLINE
DCOM- 20160316
LR  - 20231111
IS  - 2219-2840 (Electronic)
IS  - 1007-9327 (Print)
IS  - 1007-9327 (Linking)
VI  - 21
IP  - 24
DP  - 2015 Jun 28
TI  - Evolution of nonspecific duodenal lymphocytosis over 2 years of follow-up.
PG  - 7545-52
LID - 10.3748/wjg.v21.i24.7545 [doi]
AB  - AIM: To assess the evolution of duodenal lymphocytosis (DL), a condition 
      characterized by increased intraepithelial lymphocytes (IELs), over 2 years of 
      follow-up. METHODS: Consecutive patients undergoing upper endoscopy/histology for 
      abdominal pain, diarrhea, weight loss, weakness or other extraintestinal features 
      compatible with celiac disease (CD) were included. Evaluation of IELs infiltrate 
      in duodenal biopsy samples was carried out by CD3-immunohistochemistry and 
      expressed as number of positive cells/100 enterocytes. Diagnostic agreement on 
      the IELs count was tested by calculating the weighted k coefficient. All patients 
      underwent serological detection of autoantibodies associated with CD: IgG and IgA 
      anti-tissue transglutaminase and endomysium. Each patient underwent further 
      investigations to clarify the origin of DL at baseline and/or in the course of 2 
      years of follow-up every six months. Autoimmune thyroiditis, intestinal 
      infections, parasitic diseases, bacterial intestinal overgrowth, hypolactasia and 
      wheat allergy were detected. Colonoscopy and enteric magnetic resonance imaging 
      were performed when necessary. Risk factors affecting the final diagnosis were 
      detected by multinomial logistic regression and expressed as OR. RESULTS: 
      Eighty-five patients (16 males, 69 females, aged 34.1 +/- 12.5 years) were followed 
      up for a mean period of 21.7 +/- 11.7 mo. At baseline, endoscopy/duodenal biopsy, 
      CD3 immunohistochemistry revealed: > 25 IELs/100 enterocytes in 22 subjects, 
      15-25 IELs in 37 and < 15 IELs in 26. They all had negative serum 
      anti-transglutaminase and anti-endomysium, whilst 5 showed IgG anti-gliadin 
      positivity. In the course of follow-up, 23 developed CD seropositivity and gluten 
      sensitivity (GS) was identified in 19. Other diagnoses were: 5 Helicobacter 
      pylori infections, 4 jejunal Crohn's disease, 1 lymphocytic colitis and 1 
      systemic sclerosis. The disease in the remaining 32 patients was classified as 
      irritable bowel syndrome because of the lack of diagnostic evidence. At 
      multivariate analysis, the evolution towards CD was associated with an IELs 
      infiltrate > 25 (OR = 1640.4) or 15-25 (OR = 16.95), human leukocyte antigen 
      (HLA) DQ2/8 (OR = 140.85) or DQA1*0501 (OR = 15.36), diarrhea (OR = 5.56) and 
      weakness (OR = 11.57). GS was associated with IELs 15-25 (OR = 28.59), autoimmune 
      thyroiditis (OR = 87.63), folate deficiency (OR = 48.53) and diarrhea (OR = 
      54.87). CONCLUSION: DL may have a multifactorial origin but the IELs infiltrate 
      and HLA are strong predictive factors for CD development and a clinical diagnosis 
      of GS.
FAU - Losurdo, Giuseppe
AU  - Losurdo G
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Piscitelli, Domenico
AU  - Piscitelli D
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Giangaspero, Antonio
AU  - Giangaspero A
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Principi, Mariabeatrice
AU  - Principi M
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Buffelli, Francesca
AU  - Buffelli F
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Giorgio, Floriana
AU  - Giorgio F
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Montenegro, Lucia
AU  - Montenegro L
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Sorrentino, Claudia
AU  - Sorrentino C
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Amoruso, Annacinzia
AU  - Amoruso A
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Ierardi, Enzo
AU  - Ierardi E
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
FAU - Di Leo, Alfredo
AU  - Di Leo A
AD  - Giuseppe Losurdo, Domenico Piscitelli, Antonio Giangaspero, Mariabeatrice 
      Principi, Francesca Buffelli, Floriana Giorgio, Lucia Montenegro, Claudia 
      Sorrentino, Annacinzia Amoruso, Enzo Ierardi, Alfredo Di Leo, Gastroenterology 
      Section, Department of Emergency and Organ Transplantation, University of Bari, 
      70124 Bari, Italy.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Gastroenterol
JT  - World journal of gastroenterology
JID - 100883448
RN  - 0 (Autoantibodies)
RN  - 0 (Biomarkers)
RN  - 0 (CD3 Complex)
RN  - 0 (HLA Antigens)
RN  - 8002-80-0 (Glutens)
SB  - IM
MH  - Adult
MH  - Autoantibodies/blood
MH  - Biomarkers/analysis
MH  - Biopsy
MH  - CD3 Complex/analysis
MH  - Celiac Disease/*diagnosis/immunology/pathology
MH  - Chi-Square Distribution
MH  - Colonoscopy
MH  - Disease Progression
MH  - Duodenal Diseases/*diagnosis/immunology/pathology
MH  - Duodenoscopy
MH  - Duodenum/immunology/*pathology
MH  - Female
MH  - Follow-Up Studies
MH  - Food Hypersensitivity/*diagnosis/immunology/pathology
MH  - Glutens/*adverse effects/immunology
MH  - HLA Antigens/analysis
MH  - Humans
MH  - Immunohistochemistry
MH  - Intestinal Mucosa/immunology/*pathology
MH  - Logistic Models
MH  - Lymphocytes/immunology/*pathology
MH  - Lymphocytosis/*diagnosis/immunology/pathology
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Factors
MH  - Serologic Tests
MH  - Time Factors
MH  - Young Adult
PMC - PMC4481450
OTO - NOTNLM
OT  - Celiac disease
OT  - Duodenal lymphocytosis
OT  - Gluten sensitivity
OT  - Immunohistochemistry
OT  - Intraepithelial lymphocytes
OT  - Seronegative celiac disease
EDAT- 2015/07/04 06:00
MHDA- 2016/03/17 06:00
PMCR- 2015/06/28
CRDT- 2015/07/04 06:00
PHST- 2015/01/22 00:00 [received]
PHST- 2015/03/31 00:00 [revised]
PHST- 2015/05/07 00:00 [accepted]
PHST- 2015/07/04 06:00 [entrez]
PHST- 2015/07/04 06:00 [pubmed]
PHST- 2016/03/17 06:00 [medline]
PHST- 2015/06/28 00:00 [pmc-release]
AID - 10.3748/wjg.v21.i24.7545 [doi]
PST - ppublish
SO  - World J Gastroenterol. 2015 Jun 28;21(24):7545-52. doi: 10.3748/wjg.v21.i24.7545.