RESUMEN
Background: Seronegative celiac disease (CD) poses a diagnostic challenge. Aims: Characterize and identify differences between seronegative and seropositive CD. Patients and methods: Retrospective cohort study examining adult patients diagnosed with CD (1980-2017). Clinical, analytical, histological, genetic and immunophenotypic data were compiled. Seronegative CD was defined as a anti-tissue transglutaminase type 2 IgA and endomysial antibodies (EMA) negative and HLA-DQ2 and/or DQ8 positive, showing clinical signs of CD plus an abnormal duodenal biopsy, and responding to a gluten-free diet (GFD). Factors associated with seronegative CD were identified through binomial logistic regression. Results: Of 315 CD patients, 289 were seropositive (91.7%) and 26 seronegative (8.3%). Among the seronegative patients, higher prevalence was observed for autoimmune thyroiditis (26.9% vs. 9.7%, p = .016), HLA-DQ8 heterozygosity (23.1% vs. 2.5%, p Ë .001) and Marsh I lesion (34.6% vs. 3.7%, p Ë .001). The two groups showed similar flow cytometry-determined duodenal immunophenotypes and rates of refractory CD. Conclusions: Seronegative CD differs mostly in genetic (more HLA-DQ8) and histologic (milder atrophy) features as compared with seropositive. Intestinal intraepithelial immunophenotype by flow cytometry, similar in both modalities, is a useful tool to diagnose seronegative CD.
Asunto(s)
Enfermedad Celíaca/genética , Enfermedad Celíaca/patología , Duodeno/patología , Linfocitos/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atrofia , Autoanticuerpos/sangre , Biopsia , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/dietoterapia , Dieta Sin Gluten , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/genética , Enfermedades Duodenales/patología , Femenino , Citometría de Flujo , Proteínas de Unión al GTP/sangre , Antígenos HLA-DQ/genética , Humanos , Inmunoglobulina A/inmunología , Mucosa Intestinal/patología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Proteína Glutamina Gamma Glutamiltransferasa 2 , Estudios Retrospectivos , Transglutaminasas/sangre , Adulto JovenRESUMEN
BACKGROUND: Permanent changes have been found in intraepithelial lymphocyte (IEL) subsets in patients with celiac disease. OBJECTIVE: The main aim of this study was to demonstrate the utility of determining CD3()/CD7(+) and T cell receptor (TCR) gamma-delta IEL subsets by flow cytometry as a diagnostic marker of adult celiac disease. PATIENTS AND METHODS: We performed a prospective study in a sample of 128 adult patients (70 with celiac disease and 58 controls). In all patients, distal duodenal biopsy was performed and IEL subsets were determined by flow cytometry. RESULTS: Patients with celiac disease showed an increase in gamma-delta IEL subsets and a decrease in CD3(-)/CD7(+) IEL subsets in comparison with the control group, independently of diet. CONCLUSIONS: The results indicate that IEL subset determination by flow cytometry could be useful to confirm diagnosis of celiac disease. IEL subsets should be investigated in diseases other than celiac disease, as well as in patients with potential or latent celiac disease.
Asunto(s)
Enfermedad Celíaca/patología , Duodeno/patología , Mucosa Intestinal/patología , Receptores de Antígenos de Linfocitos T gamma-delta/análisis , Subgrupos de Linfocitos T/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígenos CD7/análisis , Complejo CD3/análisis , Enfermedad Celíaca/dietoterapia , Dieta Sin Gluten , Duodenoscopía , Duodeno/inmunología , Femenino , Citometría de Flujo , Enfermedades Gastrointestinales/inmunología , Enfermedades Gastrointestinales/patología , Antígenos HLA-D/análisis , Humanos , Mucosa Intestinal/inmunología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
INTRODUCCIÓN: Se han apreciado cambios permanentes enlas subpoblaciones de linfocitos intraepiteliales (LIE) en lospacientes con enfermedad celíaca.OBJETIVO: El objetivo principal de este estudio fue demostrarla utilidad de la determinación de las subpoblaciones deLIE receptores de células T gamma-delta y CD3/CD7+, mediantecitometría de flujo, como marcador diagnóstico de laenfermedad celíaca del adulto.PACIENTES Y MÉTODOS: Para ello, hemos realizado un estudioprospectivo sobre una muestra de 128 pacientes adultos (70con enfermedad celíaca y 58 controles). A todos ellos se lesrealizaron biopsias de duodeno distal, que fueron procesadasmediante citometría de flujo para la determinación desubpoblaciones de LIE.RESULTADOS: Según los resultados obtenidos, la muestra depacientes celíacos presenta un aumento de la subpoblaciónde LIE gamma-delta y un descenso en la subpoblación deLIE CD3/CD7+, independientemente de la dieta realizada,cuando se comparan con el grupo control.CONCLUSIONES: Según los datos obtenidos, se puede concluirque la determinación de subpoblaciones de LIE mediante citometríade flujo podría resultar de utilidad para confirmarel diagnóstico de enfermedad celíaca. Sería necesario investigarlas subpoblaciones de linfocitos intraepiteliales en otrasenfermedades distintas de la enfermedad celíaca, así como enpacientes con enfermedad celíaca latente o potencial
BACKGROUND: Permanent changes have been found in intraepitheliallymphocyte (IEL) subsets in patients with celiacdisease.OBJECTIVE: The main aim of this study was to demonstratethe utility of determining CD3/CD7+ and T cell receptor(TCR) gamma-delta IEL subsets by flow cytometry as adiagnostic marker of adult celiac disease.PATIENTS AND METHODS: We performed a prospective studyin a sample of 128 adult patients (70 with celiac disease and58 controls). In all patients, distal duodenal biopsy was performedand IEL subsets were determined by flow cytometry.RESULTS: Patients with celiac disease showed an increase ingamma-delta IEL subsets and a decrease in CD3/CD7+ IELsubsets in comparison with the control group, independentlyof diet.CONCLUSIONS: The results indicate that IEL subset determinationby flow cytometry could be useful to confirm diagnosisof celiac disease. IEL subsets should be investigated in diseasesother than celiac disease, as well as in patients withpotential or latent celiac disease