Clinical outcome of patients with raised intraepithelial lymphocytes (IELs) with normal villous architecture on duodenal biopsy
Department of Gastroenterology& TAAG AMNCH; Tallaght Hospital
The Finding of a raised intraepithelial lymphocytes (IEL) count with normal villous architecture is of sufficient clinical importance to be reported in routine duodenal biopsies and remains a management challenge.
To determine the long-term clinical relevance of isolated increased IELs on random duodenal biopsy in an Irish cohort, with reference to subsequent coeliac disease development.
A single tertiary center retrospective observational cohort study was undertaken. Patients from 2012 to 2014, >18 years with at least one biopsy from the second part of the duodenum with increased IELs; defined as >25IELS/100 enterocytes, with preserved villous architecture were identified from our histopathology database. Patients were excluded if they had a history of Coeliac Disease (CD). Clinical and demographic data were recorded following a chart review. CD was diagnosed by the attending Physician based on the Physician Global Assessment. Data was compared between groups using a student t-test and odds ratios were calculated as appropriate. Statistical significance was set a priori at p < 0.05. preprocess
Over 24 months 6,244 patients had duodenal biopsies and 114(1.8%) had isolated increased IELs. The mean age was 50 years (19-91) and 34(30%) were male. Follow-up was available in 75(65%), with a mean duration of 22 months. CD was subsequently diagnosed in 32% (n=24). CD was associated with female gender 22/24 v 39/51, OR 7.5, p<0.05, 95%CI 0.74-0.01 and older age 55 v 41 years, p< 0.04, 95%CI 26.8- 0.28, In addition, a higher IEL count was predictive of CD with an IEL of > 40 in 11/24 (46%) with CD v 12/51 (24%) without CD, p=0.0006, OR 5.6, 95% CI -0.54 to –0.15. Overall raised IEL’s could be attributed to CD in 24 (32%), associated conditions / medications in 21(28%), H.Pylori infection in 14 (19%) and no cause was found in 24 (32%).
Raised IEL’s are a frequent non-specific but important finding. In our cohort, a third of patients subsequently developed CD. Of import a negative baseline TTG does not exclude CD development, NPV 85%. Close follow-up of older female patients and those with IEL’s> 40 is supported by this data.