Villous tip intraepithelial lymphocytes as markers of early‐stage coeliac disease

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Abstract
Background: An investigation was conducted to determine whether the density of small‐intestinal villous tip intraepithelial lymphocytes would be of value in clinical practice in uncovering early‐stage coeliac disease. Methods: Villous tip, CD3+ and γδ+ intraepithelial lymphocytes were counted in patients with definite early‐stage coeliac disease without villous atrophy, in classic coeliac disease with manifest mucosal lesion and in non‐coeliac controls with normal mucosal structure. Villous tip analysis was made of haematoxylin‐eosin specimens and CD3+ and γδ+ of immunohistochemical stainings from frozen samples. Results: The villous tip intraepithelial lymphocyte count was statistically significantly higher in patients with early‐stage coeliac disease than in non‐coeliac controls. The sensitivity of this method to detect untreated coeliac disease with normal villous architecture was 0.84; the specificity was 0.88. This method proved superior to CD3+ analysis and was at least as good as γδ+ analysis in detecting early‐stage coeliac disease. In detecting classic coeliac disease, villous tip analysis also reached a higher sensitivity than CD3+ and γδ+ cells. Conclusions: Villous tip analysis seems to distinguish early coeliac from non‐specific changes, thus providing a valuable tool in routine practice, especially when borderline findings are involved. Its value appears to be similar to counting of γδ+ cells, which, however, requires frozen biopsy samples.