A prospective study into the aetiology of lymphocytic duodenosis
Article first published online: 4 OCT 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 32, Issue 11-12, pages 1392–1397, December 2010
How to Cite
Aziz, I., Evans, K. E., Hopper, A. D., Smillie, D. M. and Sanders, D. S. (2010), A prospective study into the aetiology of lymphocytic duodenosis. Alimentary Pharmacology & Therapeutics, 32: 1392–1397. doi: 10.1111/j.1365-2036.2010.04477.x
- Issue published online: 2 NOV 2010
- Article first published online: 4 OCT 2010
- Publication data Submitted 15 July 2010 First decision 4 August 2010 Resubmitted 28 August 2010 Accepted 13 September 2010 EV Pub Online 4 October 2010
Aliment Pharmacol Ther 2010; 32: 1392–1397
Background Lymphocytic duodenosis is defined by normal villous architecture and intraepithelial lymphocytes (IELs) >25 per 100 enterocytes. Such patients should not be diagnosed with coeliac disease, solely by histology, as previous retrospective studies have suggested other associations with lymphocytic duodenosis.
Aim To study prospectively the aetiology of lymphocytic duodenosis.
Methods One hundred patients with lymphocytic duodenosis were investigated rigorously for coeliac disease and other known associations for lymphocytic duodenosis by initial investigations of coeliac serology, and exclusion of infection. Of 34 with no explanation for lymphocytic duodenosis, 29 underwent repeat duodenal biopsies following a gluten challenge.
Results Coeliac disease was present in 16% of patients with lymphocytic duodenosis. In the absence of a positive coeliac diagnosis, lymphocytic duodenosis was most commonly associated with drugs (21%), infection (19%), immune dysregulation (4%), inflammatory bowel disease (2%), microscopic colitis (2%), sarcoidosis (1%) and IgA deficiency (1%). Of 34 with no known associations, 18 had symptoms of irritable bowel syndrome (IBS), and in 29 patients investigated with repeat duodenal biopsies, the IEL count returned to normal in 22.
Conclusions In 66% of cases of lymphocytic duodenosis, a known association can be found by further investigations; importantly, 16% will have coeliac disease. In those with no apparent cause, there may be an association with IBS and the IEL count becomes normal on repeat biopsy in 76%.