TY - JOUR
T1 - The significance of duodenal mucosal atrophy in patients with common variable immunodeficiency
T2 - A clinical and histopathologic study
AU - Biagi, Federico
AU - Bianchi, Paola I.
AU - Zilli, Alessandra
AU - Marchese, Alessandra
AU - Luinetti, Ombretta
AU - Lougaris, Vassilios
AU - Plebani, Alessandro
AU - Villanacci, Vincenzo
AU - Corazza, Gino R.
PY - 2012/8
Y1 - 2012/8
N2 - Gastrointestinal manifestations and villous atrophy can be seen in patients with common variable immunodeficiency (CVID). In some patients, infectious agents may be responsible, whereas in others, celiac disease (CD) may be the cause. In this study, we investigate the causes and the histopathologic features seen in patients with CVID. Eleven patients with CVID and villous atrophy underwent duodenal biopsies, human leukocyte antigen (HLA) typing, and testing for all celiac antibodies. Fifteen patients with CVID and normal villi and 6 patients with CD but without CVID served as controls. Histologic response to a gluten-free diet (GFD) allowed a diagnosis of CD in 3 of 11 patients. In the remaining 8, the lack of a histologic response to a GFD or HLA typing excluded CD. Celiac antibodies gave conflicting results and were of no help. Polymorphonuclear infiltrates and lesions like graft-versus-host disease are seen more often in flat mucosa unresponsive to a GFD. However, the specificity of these findings remains to be determined and response to a GFD remains the only diagnostic criteria for CD in these patients. Villous atrophy was gluten-sensitive in 3 of 11 patients with CVID. It was not related to gluten-responsive CD in most patients. Copyright
AB - Gastrointestinal manifestations and villous atrophy can be seen in patients with common variable immunodeficiency (CVID). In some patients, infectious agents may be responsible, whereas in others, celiac disease (CD) may be the cause. In this study, we investigate the causes and the histopathologic features seen in patients with CVID. Eleven patients with CVID and villous atrophy underwent duodenal biopsies, human leukocyte antigen (HLA) typing, and testing for all celiac antibodies. Fifteen patients with CVID and normal villi and 6 patients with CD but without CVID served as controls. Histologic response to a gluten-free diet (GFD) allowed a diagnosis of CD in 3 of 11 patients. In the remaining 8, the lack of a histologic response to a GFD or HLA typing excluded CD. Celiac antibodies gave conflicting results and were of no help. Polymorphonuclear infiltrates and lesions like graft-versus-host disease are seen more often in flat mucosa unresponsive to a GFD. However, the specificity of these findings remains to be determined and response to a GFD remains the only diagnostic criteria for CD in these patients. Villous atrophy was gluten-sensitive in 3 of 11 patients with CVID. It was not related to gluten-responsive CD in most patients. Copyright
KW - Celliac disease
KW - Common variable immunodeficiency
KW - Endomysial antibodies
KW - Gluten
KW - Gluten-free diet
KW - Hypogammaglobulinemia
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U2 - 10.1309/AJCPEIILH2C0WFYE
DO - 10.1309/AJCPEIILH2C0WFYE
M3 - Article
C2 - 22904128
AN - SCOPUS:84865425398
VL - 138
SP - 185
EP - 189
JO - American Journal of Clinical Pathology
JF - American Journal of Clinical Pathology
SN - 0002-9173
IS - 2
ER -