Duodenal inthraepithliel lymphocytosis???? Anyone?

[Toritagg]

Anyone know what this means? I understand that its the same Lymphocytes found in the colon on an LC diagnosis- but found in the small intestine.. but not sure if I understand waht it means-- Is this the same as actual celiac??

[tex]

Intraepithelial lymphocytosis is the primary diagnostic marker of LC, so duodenal intraepithelial lymphocytosis simply means that the duodenum has exactly the same pattern of inflammation as a colon that qualifies for a diagnosis of LC. IOW, that diagnosis simply verifies that MC can affect any part of the digestive system, and FWIW (contrary to what most GI specialists believe), it almost always also affects the small intestine, in most patients, in addition to the colon. Unfortunately, when the original description of MC was recorded, it was incorrectly limited to the colon, so doctors don't know what to call the inflammation when they find it elsewhere in the GI tract.

There are plenty of research data to verify my claim. To save time, I'll just quote from chapter 9 in my book, (from pages 110–112):

Are celiac disease and microscopic colitis actually symptoms of another disease?
Many research reports point out that the laboratory markers and the clinical symptoms of the two syndromes are very similar. Both celiac disease and microscopic colitis are associated with an elevated lymphocyte count in the mucosa of the intestine. With celiac disease, the lymphocytic infiltration eventually leads to villus atrophy in the small intestine. This is typically true if the patient has either a DQ2 or a DQ8 gene.11 Note that an early stage of celiac disease, known as Marsh stage 1 enteropathy, is marked by an intraepithelial lymphocyte count greater than 30 lymphocytes per 100 enterocytes.12

However, even though histological changes in the colon are not a diagnostic criteria for celiac disease, researchers have long known that with celiac disease, not only is the small intestine inflamed, but typically so is the colon and the stomach.13 As evidence of this, Wolber et al. (1990) stated:

These findings indicate that sprue-associated colonic lymphocytosis and lymphocytic colitis are histologically, quantitatively, and immunohistochemically indistinguishable, that the epithelial T cell infiltration of celiac sprue occurs in glandular mucosa at all levels of the gastrointestinal tract, and that colonic subepithelial collagen deposition in patients with celiac sprue is an infrequent occurrence. These findings also suggest that gastrointestinal epithelial T cell infiltration may be an immunologic response that is common in individuals sensitized to absorbed lumenal antigens, and that colonic lymphocytosis may occur as a response to a number of antigens, including gluten. (p. 1092)

In 1998 Fine et al. concluded, “In contrast, colonic histopathology in refractory sprue is indistinguishable from lymphocytic colitis, although immunohistochemical differences do exist.” (p. 1433).14 Clearly then, both celiac disease and microscopic colitis cause identical cellular changes in the mucosa of the colon.

And even though no mention of the small intestine is made in the diagnostic criteria for microscopic colitis, researchers have found that lymphocytic infiltration is frequently present in the small intestine of MC patients, and in some cases, villus damage is sufficient to justify a diagnosis of celiac disease. Even when the formal diagnostic criteria for celiac disease are not met, a significant number (over 10 %) of microscopic colitis patients show at least a Marsh 1 level of villus damage upon biopsy analysis of their small intestine.15

In fact, small intestinal involvement is quite common with MC.16 Other researchers have noted that the T helper cell type 1 mucosal cytokine response pattern exhibited by microscopic colitis is very similar to the response pattern of celiac disease.17 Most researchers have been unsure how to classify this type of information, since it implies non-celiac gluten sensitivity.18 Often, biopsy samples of the terminal ileum are taken during a colonoscopy exam, and upon examination under a microscope, those samples typically show lymphocytic infiltration for most patients who have MC.19

Koskela (2011) even noted that in general, the duodenum of patients with MC, excluding any patients who have celiac disease, have shorter villi than controls.19 Of course since no villi exist in the colon, villus atrophy cannot occur in the colon, but that is irrelevant to this comparison. According to Stewart et al. (2011) the association between celiac disease and microscopic colitis is so strong, that for someone diagnosed with either of the two diseases, the odds that they will also meet the diagnostic criteria of the other disease, has been shown to be approximately 50 times the level that would typically be expected in the general population.20

Here are references 11–20, noted in that quote:

11. Biagi, F., Luinetti, O., Campanella, J., Klersy, C., Zambelli, C., Villanacci, V., . . . Corazza, G. R. (2004). Intraepithelial lymphocytes in the villous tip: Do they indicate potential coeliac disease? Journal of Clinical Pathology, 57(8), 835–839. doi:10.1136/jcp.2003.013607

12. Dickey, W. (2008, September). Celiac disease and the colon. Practical Gastroenterology 44(1), 40–45. Retrieved from http://www.practicalgastro.com/pdf/Sept ... rticle.pdf

13. Wolber, R., Owen, D., & Freeman, H. (1990). Colonic lymphocytosis in patients with celiac sprue. Human Pathology, 21(11), 1092–1096. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2227917

14. Fine, K. D., Lee, E. L., & Meyer, R. L. (1998). Colonic histopathology in untreated celiac sprue or refractory sprue: is it lymphocytic colitis or colonic lymphocytosis? Human Pathology, 29(12), 1433–1440. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9865829

15. Simondi, D., Pellicano, R., Reggiani, S., Pallavicino, F., David, E., Sguazzini, C., . . . Astegiano, M. (2010). A retrospective study on a cohort of patients with lymphocytic colitis. Spanish Journal of Gastroenterology, 102(6), 381–384. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20575599

16. Moayyedi, P., O'Mahony, S., Jackson, P., Lynch, D. A., Dixon, M. F., & Axon, A. T. (1997). Small intestine in lymphocytic and collagenous colitis: mucosal morphology, permeability, and secretory immunity to gliadin. Journal of Clinical Pathology, 50(6), 527–529. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC500002/

17. Tagkalidis, P. P., Gibson, P. R., & Bhathal, P. S. (2007). Microscopic colitis demonstrates a T helper cell type 1 mucosal cytokine profile. Journal of Clinical Pathology, 60(4), 382–387. doi:10.1136/jcp.2005.036376

18. Vande Voort, J. L., Murray, J. A., Lahr, B. D., Van Dyke, C. T., Kroning, C. M., Moore, B., & Wu, T-T. (2009). Lymphocytic duodenosis and the spectrum of celiac disease. American Journal of Gastroenterology, 104(1), 142–148. doi:10.1038/ajg.2008.7

19. Koskela, R. (2011). Microscopic colitis: Clinical features and gastroduodenal and immunogenic findings. (Doctoral dissertation, University of Oulu). Retrieved from http://herkules.oulu.fi/isbn97895142941 ... 294150.pdf

20. Stewart, M., Andrews, C. N., Urbanski, S., Beck, P. L., & Storr, M. (2011). The association of coeliac disease and microscopic colitis: A large population-based study. Alimentary Pharmacology & Therapeutics, 33(12), 1340–1349. Retrieved from http://www.medscape.com/viewarticle/743 ... mp&spon=20

I hope that addresses your question.

Tex

[Toritagg]

Awesome! Thank you so much for the info Tex!

[tex]

You're most welcome.

Tex