Assessment of the percentage of intraepithelial lymphocytes in duodenal biopsy as a diagnostic tool in celiac disease

Identifier:  TFG:6620

Handle: https://hdl.handle.net/20.500.11797/TFG6620

Authors:  Cabré Margalef, Natàlia

Abstract:
The effectiveness of the diagnostic tools currently available for Celiac Disease (CD) is limited. Consequently, certain patients remain as doubtful cases, awaiting a definitive diagnosis. Flow cytometry is a diagnostic tool not commonly implemented in clinical services that could improve the efficiency of CD diagnosis. The main objective of this study is to establish a reference value by age for the percentages of LIEs, TCRγδ LIEs and CD3- LIEs in celiac patients. Additionally, we are looking to relate these markers to non-celiac disorders and assess the influence of IgA deficiency in CD. Of the 282 patients studied, who underwent a duodenal biopsy, 54.3% had a definitive diagnosis of CD, 36.2% did not have a diagnosis compatible with CD and the remaining 9.6% did not have a definitive diagnosis . The vast majority of celiac patients had positive clinical analyzes for CD: 80.3% had positive ATGT IgA and 90% positive AEM IgA, 92.8% showed histology compatible with CD, 94.7% exhibited a celiac pattern in flow cytometry, as well as a strong genetic predisposition, with 86.2% of individuals with the highest risk HLA haplotypes. Celiac and non-celiac patients showed significant differences in the percentages of TCRγδ LIEs and CD3- LIEs (p<0.05). No significant differences have been found between the absence or presence of IgA deficiency in patients with MC in relation to the percentages of LIEs, TCRγδ LIEs and CD3- LIEs. In non-celiac patients, significant differences have been observed in the percentage of LIEs between Helicobacter pylori gastritis and gluten intolerance (p<0.05), and between H. pylori gastritis and chronic gastritis or NSAIDs (p<0.05). The percentage of LIEs is not a good diagnostic tool for CD because, despite presenting a specificity greater than 80%, it showed a very low sensitivity (≤40%), and a low AUC (≤0.64). On the other hand, the percentages of TCRγδ LIEs and CD3- LIEs have shown a sensitivity and specificity greater than 80% in the evaluation of patients with and without CD, as well as in the classification according to their age (children or adults) study groups