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Gluten-free diet may not prevent intraepithelial lymphocytosis in celiac disease
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Persistent intraepithelial lymphocytosis remained common among patients with celiac disease despite a gluten-free diet in a recent study.
Researchers evaluated 177 adult patients with celiac disease who had practiced a gluten-free diet for at least 2 years before enrollment. Participants responded to questionnaires regarding their gastrointestinal and psychological symptoms, and information was collected on comorbidities, medication use, and oat and wheat starch consumption. Upper intestinal endoscopies and small-bowel biopsies were performed and malabsorption parameters, celiac serology and human leukocyte antigen-typing were determined via blood sample analyses.
Normal villous architecture was present in 170 patients, with the remaining seven participants indicating villous atrophy. Of those with normal structure, 96 participants had persistent intraepithelial lymphocytosis (IEL), and 74 had normal small-intestinal mucosa. Duration of the gluten-free diet was longer among patients with normal mucosa compared with those experiencing inflammation (median 10 years vs. 9 years, P=.014).
The presence of mucosal inflammation was linked to oat consumption (84% of patients with inflammation vs. 64% with normal morphology, P=.012 for difference). No association was found between inflammation and wheat starch consumption, age, gender, family history or Helicobacter pylori gastritis, among other factors.
Most patients with persistent IEL experienced positive clinical outcomes, with no significant differences from patients with normal small-intestinal mucosa in quality of life or the incidence of malignancies, malabsorption or gastrointestinal symptoms. The villous height-crypt death ratio was significantly lower among patients with persistent IEL than those with normal mucosa, but still was considered within the normal range (3.2 among patients with normal mucosa vs. 2.9 with inflammation, P=.042).
“Persistent small-intestinal mucosal intraepithelial lymphocytosis is a common finding in long-term treated celiac disease patients,” the researchers wrote, “but the clinical outcome of these patients does not differ from those with completely normal mucosa. Oats might contribute to the duodenal lymphocytosis, whereas drugs, H. pylori gastritis or other autoimmune diseases did not. Further studies are needed concentrating on the possible harmful effect of oats on the small-intestinal mucosa in the long term, and the phenotype of persistent IELs.”
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