Department of Pathology, Ankara University Medical School, Ankara, Turkey.
Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey.
Virchows Arch. 2022 Feb;480(2):315-322. doi: 10.1007/s00428-021-03257-5. Epub 2022 Jan 11.
Diagnosis of non-coeliac gluten sensitivity (NCGS) remains still problematic due to the subjectiveness and lack of a specific biomarker. We aimed to compare NCGS duodenal mucosae with healthy individuals and Marsh type 1 coeliac disease (CD), to determine whether NCGS has characteristic histological features. A total of 44 healthy controls, 42 NCGS, and 44 type 1 CD patients were selected according to clinical, serological, and laboratory data. Duodenal biopsies were evaluated on H&E, CD, and CD117 for villus/crypt ratio, IEL counts/100 enterocytes, uneven distribution pattern with clusters of IELs in the villous epithelium, linear distribution of T lymphocytes in the basal lamina propria, and eosinophils and mast cells in the lamina propria. IEL counts were within normal range in controls (13 ± 7.65), normal or mildly increased in NCGS (24.7 ± 10.46), and increased in CD (58.79 ± 14.97) on CD3. The presence of uneven distribution pattern of IELs in the villous epithelium was significantly higher in NCGS (90.5%), in contrast to controls (27.3%) and CD (34.1%). The presence of linear distribution of T lymphocytes in the basal lamina propria (68.2%, 76.2%, 78.1%), eosinophil counts (6.85 ± 3.42, 6.21 ± 2.8, 7.62 ± 3.89), and mast cell counts (25.1 ± 5.1, 26 ± 2.9, 30.3 ± 4.4) was similar in controls, NCGS, and CD, respectively. In conclusion, duodenal mucosae in NCGS are characterized by preserved villous architecture, normal or mildly increased IELs with clusters, and eosinophils and mast cells within normal limits. We believe uneven distribution of IELs with clusters in the villous epithelium can be used as a supportive histopathological tool for NCGS in the right clinical setting.
由于主观性和缺乏特异性生物标志物，非腹腔麸质敏感（NCGS）的诊断仍然存在问题。我们旨在比较 NCGS 十二指肠黏膜与健康个体和 Marsh 1 型乳糜泻（CD），以确定 NCGS 是否具有特征性的组织学特征。根据临床、血清学和实验室数据，共选择了 44 名健康对照者、42 名 NCGS 和 44 名 1 型 CD 患者。对十二指肠活检进行 H&E、CD 和 CD117 评估，以评估绒毛/隐窝比、IEL 计数/100 个肠上皮细胞、绒毛上皮中 IEL 簇的不均匀分布模式、基底膜固有层中的 T 淋巴细胞线性分布以及固有层中的嗜酸性粒细胞和肥大细胞。在对照组中，IEL 计数在正常范围内（13±7.65），在 NCGS 中正常或轻度增加（24.7±10.46），在 CD 中增加（58.79±14.97）在 CD3 上。在 NCGS 中，绒毛上皮中 IEL 不均匀分布模式的存在明显高于对照组（90.5%）和 CD（34.1%）。在基底膜固有层中存在 T 淋巴细胞的线性分布（68.2%、76.2%、78.1%）、嗜酸性粒细胞计数（6.85±3.42、6.21±2.8、7.62±3.89）和肥大细胞计数（25.1±5.1、26±2.9、30.3±4.4）在对照组、NCGS 和 CD 中分别相似。总之，NCGS 的十二指肠黏膜表现为绒毛结构保存，正常或轻度增加的 IEL 簇，嗜酸性粒细胞和肥大细胞在正常范围内。我们认为，在适当的临床环境下，绒毛上皮中 IEL 簇的不均匀分布可作为 NCGS 的支持性组织病理学工具。
