Duodenal lymphocytosis
Duodenal lymphocytosis | |
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Other names | Lymphocytic duodenitis, Lymphocytic duodenosis, Duodenal intraepithelial lymphocytosis |
Specialty | Gastroenterology |
Causes | Coeliac disease, environmental enteropathy and others |
Diagnostic method | Histological examination of duodenal biopsy |
Frequency | 3–7% of people having duodenal biopsy |
Duodenal lymphocytosis, sometimes called lymphocytic duodenitis, lymphocytic duodenosis, or duodenal intraepithelial lymphocytosis, is a condition where an increased number of intra-epithelial
Presentation
The condition is characterised by an increased proportion of lymphocytes in the
Causes
The list of possible causes is wide, including coeliac disease,
Diagnosis
Diagnosis is made by accurate counting of intraepithelial lymphocytes during histological examination of the duodenum.[1] The definition of the condition includes the requirement that the duodenal histological appearances are otherwise unremarkable, specifically with normal villous architecture.[2]
In
Antibodies associated with coeliac disease were reported in around 11% of cases.
Helicobacter infection is a common finding at endoscopy and although duodenal IEL counts were found to be slightly higher with this infection, this was not considered to be a meaningful cause in children.[6] Other infections, including Cryptosporidiosis and Giardiasis can also be associated with an increase in IELs.[2]
Management
The management is that of any identified associated disorder such as a
Prognosis
When duodenal lymphocytosis is associated with other features of coeliac disease, in particular positive antibodies, or HLA-DQ2/8 and a family history, treatment with a gluten-free diet produces an improvement in IEL numbers.[5] Diarrhoea, thyroiditis, weakness and folate deficiency were other predictors of the development of gluten sensitivity and coeliac disease, which developed in 23 of 85 patients over 2 years in one series.[7]