07c9c06862f318299bae56fa3cb553ac 306943.pdf 8c07a2e278b6d337755ce39852cc0672956b85e6 306943.pdf 9150453613c55b7c2521e9062c18ad6f993dc87a05935356f82527343b1873d5 306943.pdf Title: The Usefulness of Intraepithelial Lymphocyte Immunophenotype Testing for the Diagnosis of Coeliac Disease in Clinical Practice Subject: Background: The diagnosis of coeliac disease (CD) in adults is based on clinical, serological and histological criteria. The inappropriate performance of intestinal biopsies, non-specificity of mild histological lesions and initiation of a gluten-free diet (GFD) before biopsy may hamper the diagnosis. In these situations, determining the intraepithelial lymphogram of the duodenum by flow cytometry (IEL-FC) can be helpful. Objectives: To describe the clinical scenarios in which the IEL-FC is used and its impact on the diagnosis of CD. Methods: All adult patients with suspected CD at three tertiary centres for whom the duodenal histology and IEL-FC were available were identified. Catassi and Fasano’s diagnostic criteria and changes to a CD diagnosis after the IEL-FCs were collected. Results: A total of 348 patients were included. The following indications for an IEL-FC formed part of the initial study for CD (38%): negative conventional work-up (32%), already on a GFD before duodenal biopsies (29%) and refractoriness to a GFD (2%). The IEL-FC facilitated a definitive diagnosis in 93% of patients with an uncertain diagnosis who had had a conventional work-up for CD or who were on a GFD before histology. Conclusions: The IEL-FC facilitates the confirmation or rejection of a diagnosis of CD in clinical scenarios in which a conventional work-up may be insufficient. Keywords: coeliac disease; gluten-free diet; immunophenotype; intraepithelial lymphocytes Author: Laura Gutiérrez-Rios, Margalida Calafat, Irene Pascual, Cristina Roig, Aina Teniente-Serra, Laia Vergés, Carlos González-Muñoza, Eva Vayreda, Diego Vázquez, Jordi Gordillo, Míriam Mañosa, Consuelo Ramírez, Esther Garcia-Planella, Montserrat Planella and Eugeni Domènech Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Mon May 27 03:20:02 2024 CEST ModDate: Mon May 27 03:24:33 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 9 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1117147 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- DPDBQY+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 BCQHHA+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 OQBDCC+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 JRCKIS+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 DRZUJM+VnURWPalladioL Type 1 Custom yes yes yes 32 0 HGMNRX+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 48 0 OTKHWC+CMSY10 Type 1 Builtin yes yes yes 65 0 RJDPUF+EURM10 Type 1 Builtin yes yes yes 70 0 QDLGPS+URWPalladioL-BoldItal Type 1 Custom yes yes yes 81 0 FKIBFG+PalatinoLinotype CID TrueType Identity-H yes yes yes 107 0 FKIIMC+TimesNewRoman CID TrueType Identity-H yes yes yes 113 0 FKIIND+Calibri CID TrueType Identity-H yes yes yes 119 0 FKIBFJ+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 125 0 FKIBEG+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 128 0 FKIBFH+PalatinoLinotype TrueType WinAnsi yes yes no 131 0 FKICGE+PalatinoLinotype TrueType MacRoman yes yes no 134 0 FKIBFG+PalatinoLinotype CID TrueType Identity-H yes yes yes 179 0 FKIIMC+TimesNewRoman CID TrueType Identity-H yes yes yes 185 0 FKIIND+Calibri CID TrueType Identity-H yes yes yes 191 0 FKIBFJ+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 197 0 FKIBEG+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 200 0 FKIBFH+PalatinoLinotype TrueType WinAnsi yes yes no 203 0 FKICGE+PalatinoLinotype TrueType MacRoman yes yes no 206 0 JHYTSG+CMR10 Type 1 Builtin yes yes yes 236 0 FKIBDF+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 252 0 FKIBEG+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 258 0 FKIBFG+PalatinoLinotype CID TrueType Identity-H yes yes yes 261 0 FKIBFH+PalatinoLinotype TrueType WinAnsi yes yes no 267 0 FKIBFI+PalatinoLinotype,Italic CID TrueType Identity-H yes yes yes 270 0 FKIBFJ+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 276 0 FKICGE+PalatinoLinotype TrueType MacRoman yes yes no 279 0 FKICGG+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 282 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-02-04 02:47:37 CET RepresentationInformation: 306943.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-02-03 11:59:16 CET Size: 1117147 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 396 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Item: Title: Statistical Analysis Destination: section.3 Item: Title: Results Destination: section.4 Item: Title: Discussion Destination: section.5 Item: Title: Conclusions Destination: section.6 Item: Title: References Destination: section.7 Info: Title: The Usefulness of Intraepithelial Lymphocyte Immunophenotype Testing for the Diagnosis of Coeliac Disease in Clinical Practice Author: Laura Gutiérrez-Rios, Margalida Calafat, Irene Pascual, Cristina Roig, Aina Teniente-Serra, Laia Vergés, Carlos González-Muñoza, Eva Vayreda, Diego Vázquez, Jordi Gordillo, Míriam Mañosa, Consuelo Ramírez, Esther Garcia-Planella, Montserrat Planella and Eugeni Domènech Subject: Background: The diagnosis of coeliac disease (CD) in adults is based on clinical, serological and histological criteria. The inappropriate performance of intestinal biopsies, non-specificity of mild histological lesions and initiation of a gluten-free diet (GFD) before biopsy may hamper the diagnosis. In these situations, determining the intraepithelial lymphogram of the duodenum by flow cytometry (IEL-FC) can be helpful. Objectives: To describe the clinical scenarios in which the IEL-FC is used and its impact on the diagnosis of CD. Methods: All adult patients with suspected CD at three tertiary centres for whom the duodenal histology and IEL-FC were available were identified. Catassi and Fasano’s diagnostic criteria and changes to a CD diagnosis after the IEL-FCs were collected. Results: A total of 348 patients were included. The following indications for an IEL-FC formed part of the initial study for CD (38%): negative conventional work-up (32%), already on a GFD before duodenal biopsies (29%) and refractoriness to a GFD (2%). The IEL-FC facilitated a definitive diagnosis in 93% of patients with an uncertain diagnosis who had had a conventional work-up for CD or who were on a GFD before histology. Conclusions: The IEL-FC facilitates the confirmation or rejection of a diagnosis of CD in clinical scenarios in which a conventional work-up may be insufficient. 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