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Persistent Intraepithelial Lymphocytosis in Celiac Patients Adhering to Gluten-Free Diet Is Not Abolished Despite a Gluten Contamination Elimination Diet

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ABSTRACT

The gluten-free diet (GFD) is the only validated treatment for celiac disease (CD), but despite strict adherence, complete mucosal recovery is rarely obtained. The aim of our study was to assess whether complete restitutio ad integrum could be achieved by adopting a restrictive diet (Gluten Contamination Elimination Diet, GCED) or may depend on time of exposure to GFD. Two cohorts of CD patients, with persisting Marsh II/Grade A lesion at duodenal biopsy after 12–18 months of GFD (early control) were identified. Patients in Cohort A were re-biopsied after a three-month GCED (GCED control) and patients in Cohort B were re-biopsied after a minimum of two years on a standard GFD subsequent to early control (late control). Ten patients in Cohort A and 19 in Cohort B completed the study protocol. There was no change in the classification of duodenal biopsies in both cohorts. The number of intraepithelial lymphocytes, TCRγδ+ (T-Cell Receptor gamma delta) T cell and eosinophils significantly decreased at GCED control (Cohort A) and at late control (Cohort B), compared to early control. Duodenal intraepithelial lymphocytosis persisting in CD patients during GFD is not eliminated by a GCED and is independent of the length of GFD. [NCT 02711696]

No MeSH data available.


Histologic Changes at the time of diagnosis, at early control and during Gluten Elimination Contamination Diet (GCED) in the number of: IntraEpithelial Lymphocytes (IEL) (a); gamma-delta CD3 (b); and eosinophils (c).
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nutrients-08-00525-f002: Histologic Changes at the time of diagnosis, at early control and during Gluten Elimination Contamination Diet (GCED) in the number of: IntraEpithelial Lymphocytes (IEL) (a); gamma-delta CD3 (b); and eosinophils (c).

Mentions: There was no change in the classification of duodenal biopsies and in VH:CD category at the end of GECD compared with results of the early control biopsies taken after a mean 15 ± 4 months of GFD. In all patients, biopsies were classified as Marsh II/Grade A with VH:CD ≥2 on both occasions (Table 2). The number of intraepithelial lymphocytes decreased from 47.9 ± 4.3 at the time of CD diagnosis to 38.5 ± 3.6 at early control biopsies (p = 0.0015) with further decrease to 32.6 ± 2.8 after GCED (p = 0.0056). The number of TCRγδ+ T cells decreased from 9.0 ± 2.1 at the time of CD diagnosis to 7.3 ± 2.1 at early control biopsies (p = 0.0006) with further decrease to 5.6 ± 2.1 after GCED (p < 0.0001). The number of eosinophils decreased from 3.8 ± 1.1 at the time of CD diagnosis to 2.3 ± 1.1 at early control biopsies (p < 0.0001) with further decrease to 1.6 ± 1.0 after GCED (p = 0.006) (Figure 2).


Persistent Intraepithelial Lymphocytosis in Celiac Patients Adhering to Gluten-Free Diet Is Not Abolished Despite a Gluten Contamination Elimination Diet
Histologic Changes at the time of diagnosis, at early control and during Gluten Elimination Contamination Diet (GCED) in the number of: IntraEpithelial Lymphocytes (IEL) (a); gamma-delta CD3 (b); and eosinophils (c).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037512&req=5

nutrients-08-00525-f002: Histologic Changes at the time of diagnosis, at early control and during Gluten Elimination Contamination Diet (GCED) in the number of: IntraEpithelial Lymphocytes (IEL) (a); gamma-delta CD3 (b); and eosinophils (c).
Mentions: There was no change in the classification of duodenal biopsies and in VH:CD category at the end of GECD compared with results of the early control biopsies taken after a mean 15 ± 4 months of GFD. In all patients, biopsies were classified as Marsh II/Grade A with VH:CD ≥2 on both occasions (Table 2). The number of intraepithelial lymphocytes decreased from 47.9 ± 4.3 at the time of CD diagnosis to 38.5 ± 3.6 at early control biopsies (p = 0.0015) with further decrease to 32.6 ± 2.8 after GCED (p = 0.0056). The number of TCRγδ+ T cells decreased from 9.0 ± 2.1 at the time of CD diagnosis to 7.3 ± 2.1 at early control biopsies (p = 0.0006) with further decrease to 5.6 ± 2.1 after GCED (p < 0.0001). The number of eosinophils decreased from 3.8 ± 1.1 at the time of CD diagnosis to 2.3 ± 1.1 at early control biopsies (p < 0.0001) with further decrease to 1.6 ± 1.0 after GCED (p = 0.006) (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

The gluten-free diet (GFD) is the only validated treatment for celiac disease (CD), but despite strict adherence, complete mucosal recovery is rarely obtained. The aim of our study was to assess whether complete restitutio ad integrum could be achieved by adopting a restrictive diet (Gluten Contamination Elimination Diet, GCED) or may depend on time of exposure to GFD. Two cohorts of CD patients, with persisting Marsh II/Grade A lesion at duodenal biopsy after 12&ndash;18 months of GFD (early control) were identified. Patients in Cohort A were re-biopsied after a three-month GCED (GCED control) and patients in Cohort B were re-biopsied after a minimum of two years on a standard GFD subsequent to early control (late control). Ten patients in Cohort A and 19 in Cohort B completed the study protocol. There was no change in the classification of duodenal biopsies in both cohorts. The number of intraepithelial lymphocytes, TCR&gamma;&delta;+ (T-Cell Receptor gamma delta) T cell and eosinophils significantly decreased at GCED control (Cohort A) and at late control (Cohort B), compared to early control. Duodenal intraepithelial lymphocytosis persisting in CD patients during GFD is not eliminated by a GCED and is independent of the length of GFD. [NCT 02711696]

No MeSH data available.