Alsaigh N, Odze R, Goldman H, Antonioli D, Ott M J, Leichtner A
Department of Pathology, Deaconess Hospital, Boston, Massachusetts, USA.
Am J Surg Pathol. 1996 Jul;20(7):865-70. doi: 10.1097/00000478-199607000-00010.
Celiac disease (CD) is associated with marked mononuclear cell inflammation in the small intestinal mucosa. This study was performed to evaluate analogous changes in the gastric and esophageal mucosa of pediatric patients with CD, with emphasis on epithelial lymphocytosis. We evaluated intraepithelial lymphocytes (IELs) in 23 gastric (no.IELs/100 epithelial cells) and 14 esophageal mucosal biopsy specimens (IELs/hpf) from 23 pediatric cases of CD and 10 nonceliac matched controls. Four patients had postgluten withdrawal biopsy specimens reviewed, and one of these had further postgluten challenge biopsy specimens evaluated as well. Gastric specimens from the CD cases showed a significantly increased IEL count (20.5 +/- 14.4; range, 4-50) compared to controls (3.4 +/- 1.9; range, 1-8; p < 0.001), which also correlated directly with the histologic severity of the small intestinal disease as assessed by the degree of villous shortening. Sixteen (69.5%) of 23 gastric specimens showed > 8 IELs, which was the highest value obtained in control specimens. The four posttreatment specimens showed a significant reduction in the gastric IEL counts from a mean of 19.8 to 3.5 IELs/100 epithelial cells (p < 0.001). The single case that had a further postgluten challenge biopsy showed a return to the pregluten withdrawal IEL count. However, the degree of gastric intraepithelial lymphocytosis did not correlate with any of the clinical data, such as age, gender, presenting symptoms, or serum antibody levels (antigliadin, antireticulin, or antiendomysium). Furthermore, no differences were observed in the IEL count in CD esophageal specimens (5.3 +/- 2.6; range, 2-10) compared to controls (5.2 +/- 1.5; range, 3-8; p = 0.935). These findings suggest that an immune-mediated lymphocytic response linked to gluten occurs in the gastric epithelium, similar to that seen in the small intestine of pediatric patients with CD. Therefore, gastric intraepithelial lymphocytosis may represent a concurrent manifestation of CD rather than a separate entity in the pediatric population.
乳糜泻（CD）与小肠黏膜中明显的单核细胞炎症相关。本研究旨在评估CD患儿胃和食管黏膜中的类似变化，重点关注上皮淋巴细胞增多情况。我们评估了23例CD患儿及10例非乳糜泻匹配对照的23份胃黏膜活检标本（每100个上皮细胞中的上皮内淋巴细胞数，IELs/100上皮细胞）和14份食管黏膜活检标本（每高倍视野的IELs，IELs/hpf）。对4例患者的麸质撤食后活检标本进行了复查，其中1例还对麸质激发后活检标本进行了进一步评估。与对照组（3.4±1.9；范围1 - 8；p<0.001）相比，CD病例的胃标本显示IEL计数显著增加（20.5±14.4；范围4 - 50），这也与通过绒毛缩短程度评估的小肠疾病组织学严重程度直接相关。23份胃标本中有16份（69.5%）显示>8个IELs，这是对照组标本中获得的最高值。4份治疗后标本显示胃IEL计数从平均19.8显著降至3.5个IELs/100上皮细胞（p<0.001）。进行了麸质激发后活检的单个病例显示IEL计数恢复到麸质撤食前水平。然而，胃上皮内淋巴细胞增多程度与任何临床数据均无相关性，如年龄、性别、就诊症状或血清抗体水平（抗麦醇溶蛋白、抗网硬蛋白或抗肌内膜抗体）。此外，与对照组（5.2±1.5；范围3 - 8；p = 0.935）相比，CD食管标本中的IEL计数（5.3±2.6；范围2 - 10）无差异。这些发现表明，与麸质相关的免疫介导淋巴细胞反应发生在胃上皮中，类似于CD患儿小肠中的情况。因此，胃上皮内淋巴细胞增多可能代表CD的并发表现，而非儿科人群中的一个独立实体。
