Spectrum of gluten-sensitive enteropathy in patients with dysmotility-like dyspepsia / Espectro de la enteropatía sensible al gluten en pacientes con dispepsia de tipo dismotilidad

Background Dysmotility-like dyspepsia symptoms are frequent in patients with gluten-sensitive enteropathy (GSE). Current data suggest that patients with mild enteropathy may be present with gluten-sensitive symptoms and complications. Aim To investigate the prevalence of GSE, including mild enteropathy, in patients with dysmotility-like dyspepsia symptoms. Methods We retrospectively studied 142 patients who presented dysmotility-like dyspepsia symptoms and normal upper gastrointestinal endoscopy. Endoscopic duodenal biopsies were taken and processed using hematoxylin–eosin staining and CD3 immunophenotyping. In patients with enteropathy (number of intraepithelial lymphocytes greater than 25 per 100 enterocytes) we also performed coeliac serology (anti-tissue transglutaminase IgA) and HLA-DQ2/DQ8 genotyping. A gluten-free diet was offered if one of these markers was positive. The final GSE diagnosis was established based on clinical and histopathological response to the gluten-free diet after 18 months of follow-up. Results Fifty-one patients (35.9%) had enteropathy; 4 (2.8%) Marsh type 3b, 24 (16.9%) Marsh type 3a, 3 (2.1%) Marsh type 2, and 20 (14.1%) Marsh type 1. A positive serology result was extremely low (6.7%) in mild enteropathy (Marsh type 1–3a) in contrast with Marsh type 3b patients (50%). Most patients with enteropathy had positive HLA DQ2 or -DQ8 genotyping (84.1%). Out of the 37 patients who started a gluten-free diet, 34 (91.9%) improved their symptoms, and 28 of 32 (87.5%) had a histopathological or serological response. A final GSE diagnosis was established in 28 of the 142 patients (19.7%).Conclusion Gluten-sensitive enteropathy can be a frequent and unsuspected cause of dysmotility-like dyspepsia (AU)

Antecedentes La dispepsia de tipo dismotilidad es frecuente en pacientes con enteropatía sensible al gluten (ESG). Los datos actuales sugieren que los pacientes con enteropatía leve pueden presentar síntomas y complicaciones gluten dependientes. Objetivo Investigar la prevalencia de ESG, incluida la enteropatía leve, en pacientes con dispepsia tipo dismotilidad. Métodos Estudio retrospectivo de 142 pacientes que presentaban dispepsia de tipo dismotilidad y normalidad en la endoscopia digestiva alta. Se realizaron biopsias duodenales y se procesaron mediante tinción de hematoxilina-eosina e inmunofenotipo CD3. En los pacientes con enteropatía (número de linfocitos intraepiteliales superior a 25 por cada 100 enterocitos) también se realizó una serología celíaca (anti-transglutaminasa tisular IgA) y genotipado HLA-DQ2/DQ8. Si uno de estos marcadores resultaba positivo, se ofrecía al paciente iniciar una dieta sin gluten. El diagnóstico final de ESG se estableció en función de la respuesta clínica e histopatológica a la dieta sin gluten después de 18 meses de seguimiento. Resultados Cincuenta y un pacientes (35,9%) presentaban enteropatía, 4 (2,8%) de Marsh tipo 3b, 24 (16,9%) Marsh tipo 3a, 3 (2,1%) Marsh tipo 2, y 20 (14,1%) Marsh tipo 1. La positividad serológica fue extremadamente baja (6,7%) en la enteropatía leve (Marsh tipo 1-3a), al contrario que en los pacientes con una lesión Marsh tipo 3b (50%). La mayoría de los pacientes con enteropatía presentaban valores positivos para el genotipado HLA DQ2 o -DQ8 (84,1%). De los 37 pacientes que iniciaron una dieta sin gluten, en 34 (91,9%) mejoraron los síntomas, y 28 de 32 (87,5%) presentaron respuesta histopatológica o serológica. Un diagnóstico final de ESG se estableció en 28 de los 142 pacientes (19,7%).Conclusión La enteropatía sensible al gluten puede ser una causa frecuente e insospechada de dispepsia de tipo dismotilidad (AU)

Spectrum of gluten-sensitive enteropathy in patients with dysmotility-like dyspepsia.

BACKGROUND: Dysmotility-like dyspepsia symptoms are frequent in patients with gluten-sensitive enteropathy (GSE). Current data suggest that patients with mild enteropathy may be present with gluten-sensitive symptoms and complications. AIM: To investigate the prevalence of GSE, including mild enteropathy, in patients with dysmotility-like dyspepsia symptoms. METHODS: We retrospectively studied 142 patients who presented dysmotility-like dyspepsia symptoms and normal upper gastrointestinal endoscopy. Endoscopic duodenal biopsies were taken and processed using hematoxylin-eosin staining and CD3 immunophenotyping. In patients with enteropathy (number of intraepithelial lymphocytes greater than 25 per 100 enterocytes) we also performed coeliac serology (anti-tissue transglutaminase IgA) and HLA-DQ2/DQ8 genotyping. A gluten-free diet was offered if one of these markers was positive. The final GSE diagnosis was established based on clinical and histopathological response to the gluten-free diet after 18 months of follow-up. RESULTS: Fifty-one patients (35.9%) had enteropathy; 4 (2.8%) Marsh type 3b, 24 (16.9%) Marsh type 3a, 3 (2.1%) Marsh type 2, and 20 (14.1%) Marsh type 1. A positive serology result was extremely low (6.7%) in mild enteropathy (Marsh type 1-3a) in contrast with Marsh type 3b patients (50%). Most patients with enteropathy had positive HLA DQ2 or -DQ8 genotyping (84.1%). Out of the 37 patients who started a gluten-free diet, 34 (91.9%) improved their symptoms, and 28 of 32 (87.5%) had a histopathological or serological response. A final GSE diagnosis was established in 28 of the 142 patients (19.7%). CONCLUSION: Gluten-sensitive enteropathy can be a frequent and unsuspected cause of dysmotility-like dyspepsia.