The significance of duodenal mucosal atrophy in patients with common variable immunodeficiency: A clinical and histopathologic study

Federico Biagi, Paola I. Bianchi, Alessandra Zilli, Alessandra Marchese, Ombretta Luinetti, Vassilios Lougaris, Alessandro Plebani, Vincenzo Villanacci, Gino R. Corazza

Research output: Contribution to journalArticlepeer-review

Abstract

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

Original languageEnglish
Pages (from-to)185-189
Number of pages5
JournalAmerican Journal of Clinical Pathology
Volume138
Issue number2
DOIs
Publication statusPublished - Aug 2012

Keywords

  • Celliac disease
  • Common variable immunodeficiency
  • Endomysial antibodies
  • Gluten
  • Gluten-free diet
  • Hypogammaglobulinemia

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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