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Duodenal Intraepithelial Lymphocytosis with Normal Villous Architecture in Pediatric Patients, 2000-2009: The Mayo Clinic Experience.
MedLine Citation:
PMID:  22785416     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: Small bowel intraepithelial lymphocytosis (IELs) with normal villous architecture is a relatively common finding, often of uncertain significance. The aims of our study were to determine 1) the prevalence of this finding, 2) its clinical associations, 3) its specificity for celiac disease (CD), and 4) whether histologic clues exist that increase the specificity for CD in this setting, all in the pediatric population. METHODS:: The Mayo Clinic electronic pathology database was searched between 1/1/2000 to 12/31/2009 for patients less than 18 years of age who had the terms "normal villi" and "increased intraepithelial lymphocytes" in their small bowel biopsy reports. All slides were reviewed to confirm the histologic findings. Demographic, serologic, pathological and clinical information was obtained. RESULTS:: Among 1290 duodenal biopsies obtained from children during the years 2000-2009, 56 (4.3%) were noted to have "normal villous architecture with increased intraepithelial lymphocytes." In the 54 patients not known to have CD prior to biopsy, 48 (89%) had serologic testing for CD. Of these 48 patients, 9 were labeled with CD, although only 5 of 9 met definite criteria for the diagnosis, based on a combination of serologic markers, HLA haplotyping and response to gluten-free diet. No clinical features pointed to a diagnosis of CD. There was no correlation between CD and numbers of IELs, but patients with newly diagnosed CD were more likely to have a tip-heavy lymphocyte distribution. Other diagnoses made during the study period and in follow-up were inflammatory bowel disease (5), H. pylori infection (3), medication-related injury (10) and systemic autoimmune disorders (2). CONCLUSIONS:: Increased IELs with normal villous architecture in small bowel biopsies is clinically important in children, and is associated with a new definite diagnosis of CD in 9% of pediatric patients. Even at this low sensitivity, clinical workup for CD is mandated in all patients with this finding.
Authors:
Eugenia Shmidt; Thomas C Smyrk; William A Faubion; Amy S Oxentenko
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-9
Journal Detail:
Title:  Journal of pediatric gastroenterology and nutrition     Volume:  -     ISSN:  1536-4801     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211545     Medline TA:  J Pediatr Gastroenterol Nutr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Department of Internal Medicine †Department of Anatomic Pathology ‡Division of Gastroenterology and Hepatology, Department of Internal Medicine §Department of Pediatric and Adolescent Medicine ||Department of Immunology; Mayo Clinic, Rochester, Minnesota.
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