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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 and late control during Gluten Free Diet (GFD) in the number of: IntraEpithelial Lymphocytes (IEL (a); gamma-delta CD3 (b); and eosinophils (c).
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nutrients-08-00525-f003: Histologic Changes at the time of diagnosis, at early and late control during Gluten Free Diet (GFD) in the number of: IntraEpithelial Lymphocytes (IEL (a); gamma-delta CD3 (b); and eosinophils (c).

Mentions: Nineteen patients enrolled in cohort B had repeated biopsies 96 ± 47 months (range 54–216) after the first control biopsy taken 16 ± 7 months (range 12–36) after starting GFD (Table 3). There was no change in classification of duodenal biopsies and in VH:CD category after long-term GFD compared with results obtained at the early control biopsy. In all patients, biopsies were classified as Marsh II/Grade A with VH:CD ≥2 on both occasions (Table 3) and in no case revealed compete normalization. The number of intraepithelial lymphocytes decreased from 45.1 ± 7.3 at the time of CD diagnosis to 41.9 ± 3.3 at the early control biopsy (p = 0.0071) with a further decrease to 34.5 ± 5.1 after long-term GFD (p = 0.0012). The number of TCRγδ+ T cells decreased from 13.0 ± 2.0 at the time of CD diagnosis to 10.5 ± 1.8 at early control biopsy (p < 0.0001) with further decrease to 9.1 ± 1.5 after long-term GFD (p < 0.0001). The number of eosinophils decreased from 4.0 ± 0.7 at the time of CD diagnosis to 2.4 ± 0.8 at early control biopsies (p < 0.0001) with further decrease to 1.4 ± 0.7 after long-term GFD (p = 0.0012) (Figure 3).


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 and late control during Gluten Free Diet (GFD) 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-f003: Histologic Changes at the time of diagnosis, at early and late control during Gluten Free Diet (GFD) in the number of: IntraEpithelial Lymphocytes (IEL (a); gamma-delta CD3 (b); and eosinophils (c).
Mentions: Nineteen patients enrolled in cohort B had repeated biopsies 96 ± 47 months (range 54–216) after the first control biopsy taken 16 ± 7 months (range 12–36) after starting GFD (Table 3). There was no change in classification of duodenal biopsies and in VH:CD category after long-term GFD compared with results obtained at the early control biopsy. In all patients, biopsies were classified as Marsh II/Grade A with VH:CD ≥2 on both occasions (Table 3) and in no case revealed compete normalization. The number of intraepithelial lymphocytes decreased from 45.1 ± 7.3 at the time of CD diagnosis to 41.9 ± 3.3 at the early control biopsy (p = 0.0071) with a further decrease to 34.5 ± 5.1 after long-term GFD (p = 0.0012). The number of TCRγδ+ T cells decreased from 13.0 ± 2.0 at the time of CD diagnosis to 10.5 ± 1.8 at early control biopsy (p < 0.0001) with further decrease to 9.1 ± 1.5 after long-term GFD (p < 0.0001). The number of eosinophils decreased from 4.0 ± 0.7 at the time of CD diagnosis to 2.4 ± 0.8 at early control biopsies (p < 0.0001) with further decrease to 1.4 ± 0.7 after long-term GFD (p = 0.0012) (Figure 3).

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.