Introduction Intestinal epithelial cell damages generated byinflammation in coeliac disease (CD) ranges from sub-microscopicto severe architectural distortion. Translation of quantitativemorphological changes in intestinal microorgans, likevillus/crypt transformation, distribution of inflammatory cellsand diagnostic cut offs, is lacking for CD and gluten relatedmicro-enteropathies.Method Investigators from 22 centres, 9 countries of 4 continents,recruited CD patients with Marsh 0-II histology(n=299), NCGS (n=151), and 262 controls. Based on anagreed protocol, epithelial morphology including intraepitheliallymphocyte (IEL) density, villus height and crypt depth weremeasured in well-oriented duodenal biopsies.Results In total 712 subjects were recruited from Australia(20), Finland (20), India (25), Iran (37), Italy (246), Romania(10), Turkey (30), UK (166) and USA (158). Preliminary analysesshowed raw IEL density (IEL/100EC) was poorly correlatedwith tTG, villus height, crypt depth or their ratios, andeven significant findings did not show strong correlation coefficients(<0.36). The IEL density cut off scored 93% sensitivityand specificity at 24/100EC for CD. However, for NCGSthe optimal sensitivity and specificity cut off was at 22IEL/100EC giving a sensitivity of 57% and specificity of 80% (seefig 1). The villus height was significantly shorter in CD comparedto either control (p<0.001) or NCGS groups(p<0.001). Also, NCGS had short villus height than control(p<0.001).Conclusion The most specific and strongest biomarker for CDwith microenteropathy is serology acting as the gold standardin this group. Villus height and crypt depth would serve ascomplementary tools in diagnosis of mild CD and NCGSpatients. NCGS seem to have a milder morphological changecompared to CD even when they present with similar Marshscores. This study also confirms the cut off of IEL for CDwith microenteropathy is similar to CD with severe enteropathyat 25 IEL/100EC.
Global translation of coeliac disease histology and other gluten related microenteropathy / K. Rostami, M. Derakhshan, A. Ensari, A. Srivastava, V. Villanacci, M. Marsh, A. Carroccio, U. Volta, A. Fasano, J.C. Bai, M. Danciu, D. Sanders, A. Sapone, C. Ciacci, L. Elli, S. Guandalini, M. Walker, L. De Magistris, H. Jericho, S. Ishaq, G. Becheanu, C. Catassi, S. Mathews, J. Going, M. Rostami-Nejad, C. Mulder, H. Mohaghegh, M. Johnson, G. Holmes, G. Bassotti, A. Bozzola, C. Ricci, A.M. Florena, R. Delsordo, R. Maxim, P. Das, G. Makharia, K. Lundin, K. Kaukinen, A. Levene, N. Fusco, A. Moradi, G. Casella, D. Hayman, C. Dibella, C. Hagen, G. Mazzarella, M. Johncilla, M. Lamba, J. Taavela, M.R. Zali, S. Liprot, C. Rodger. ((Intervento presentato al convegno British Society of Gastroenterology Annual Meeting tenutosi a Glasgow nel 2019.
Global translation of coeliac disease histology and other gluten related microenteropathy
N. Fusco;
2019
Abstract
Introduction Intestinal epithelial cell damages generated byinflammation in coeliac disease (CD) ranges from sub-microscopicto severe architectural distortion. Translation of quantitativemorphological changes in intestinal microorgans, likevillus/crypt transformation, distribution of inflammatory cellsand diagnostic cut offs, is lacking for CD and gluten relatedmicro-enteropathies.Method Investigators from 22 centres, 9 countries of 4 continents,recruited CD patients with Marsh 0-II histology(n=299), NCGS (n=151), and 262 controls. Based on anagreed protocol, epithelial morphology including intraepitheliallymphocyte (IEL) density, villus height and crypt depth weremeasured in well-oriented duodenal biopsies.Results In total 712 subjects were recruited from Australia(20), Finland (20), India (25), Iran (37), Italy (246), Romania(10), Turkey (30), UK (166) and USA (158). Preliminary analysesshowed raw IEL density (IEL/100EC) was poorly correlatedwith tTG, villus height, crypt depth or their ratios, andeven significant findings did not show strong correlation coefficients(<0.36). The IEL density cut off scored 93% sensitivityand specificity at 24/100EC for CD. However, for NCGSthe optimal sensitivity and specificity cut off was at 22IEL/100EC giving a sensitivity of 57% and specificity of 80% (seefig 1). The villus height was significantly shorter in CD comparedto either control (p<0.001) or NCGS groups(p<0.001). Also, NCGS had short villus height than control(p<0.001).Conclusion The most specific and strongest biomarker for CDwith microenteropathy is serology acting as the gold standardin this group. Villus height and crypt depth would serve ascomplementary tools in diagnosis of mild CD and NCGSpatients. NCGS seem to have a milder morphological changecompared to CD even when they present with similar Marshscores. This study also confirms the cut off of IEL for CDwith microenteropathy is similar to CD with severe enteropathyat 25 IEL/100EC.
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