Elli, Luca
Mayo Clinic
Center for Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Citations 2
Clinical Data Do Not Reliably Predict Duodenal Histology at Follow-up in Celiac Disease
Patel, Natalie, Leffler, Daniel A. , Mulder, Chris J. , Elli, Luca , Gan, Geliang , Atsawarungruangkit, Amporn, Kuijpers, Karel C., Gobbo, Alessandro Del , Goldsmith, Jeffrey D. , Hintze, Zach, Pacheco, M. Cristina, Vieth, Michael , Melcher, Bálint , Pai, Rish K. , Hart, John , Olivas, Andrea D. , Naini, Bita V. , Meyerson, Cherise, Choi, Won‐Tak , Kakar, Sanjay , Westerhoff, Maria , Cheng, Jerome , Gopal, Purva , Hammer, Suntrea T.G. , Prats, Mariana Moreno, Bronner, Mary P. , Robert, Marie E. , Pai, Rish, Elli, Luca , Al-Toma, Abdulbaqi A. , Patil, Pallavi, Salomao, Marcela , Hart, John A L , Kakar, Sanjay
American Journal of Surgical Pathology | November 23, 2023 | Volume: 48 | Issue: 2 | Pages: 212-220
Validated nonbiopsy methods to assure duodenal mucosal healing in celiac disease are lacking, yet ongoing mucosal injury is associated with anemia, osteoporosis, and lymphoma. Most providers utilize clinical data as surrogates of mucosal status to avoid additional esophagogastroduodenoscopy. The reliability of such surrogates to predict mucosal recovery has been incompletely evaluated. The aim of this study was to rigorously assess patterns of histologic mucosal recovery at follow-up in celiac disease and to correlate findings with clinical data. Gastrointestinal pathologists from 13 centers evaluated initial and follow-up duodenal biopsies from 181 celiac disease patients. Marsh scores and intraepithelial lymphocytes (IELs)/100 enterocytes were assessed blindly. Histology at follow-up was correlated with symptoms, immunoglobulin A anti–tissue transglutaminase titers and gluten-free diet adherence. Fifty-six/181 (31%) patients had persistent villous blunting and 46/181 (25%) patients had just persistently elevated IELs at follow-up, with only 79/181 (44%) patients having complete histologic remission. IEL normalization (82/181; 45%) lagged villous recovery (125/181;69%). In a minority of patients, villous blunting was limited to proximal duodenal biopsies. No correlation was found between Marsh scores and symptoms, normalization of immunoglobulin A anti–tissue transglutaminase serology, or diet adherence. Children showed greater recovery of Marsh score (P<0.001) and IELs (P<0.01) than adults. Persistent mucosal injury is common in celiac disease, with discordant villous/IEL normalization. Pathologist awareness of expected findings in celiac disease follow-up biopsies, including their frequent lack of correlation with clinical data, is important for patient management, and has implications for eligibility criteria for therapeutics currently in development.
Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study
Rostami, Kamran , Ensarı, Arzu , Marsh, Michael N. , Villanacci, Vincenzo , Aghdaei, Hamid Asadzadeh , Bai, Julio C. , Bassotti, Gabrio , Becheanu, Gabriel , Bell, Phoenix , Bella, Camillo Di, Bozzola, Anna, Cadei, Moris, Casella, Giovanni , Ciacci, Carolina , Ciobanu, Delia , Danciu, Mihai , Das, Prasenjit , Drage, Michael G. , Elli, Luca , Fasano, Alessio , Florena, Ada Maria , Fusco, Nicola , Guandalini, Stefano , Hayman, David T. S. , Ishaq, Sauid , Jericho, Hilary , Johncilla, Melanie , Johnson, Matt, Kaukinen, Katri , Levene, Adam, Liptrot, Sarah, Lu, Laura , Makharia, Govind , Mathews, Sherly, Mazzarella, Giuseppe , Maxim, Roxana, Myint, Khun La Win, Shalmani, Hamid Mohaghegh , Moradi, Afshin , Mulder, Chris J. , Ray, Ronnie, Ricci, Chiara , Rostami‐Nejad, Mohammad , Sapone, Anna, Sanders, David S. , Taavela, Juha , Volta, Umberto , Walker, Marjorie M. , Carroccio, Antonio , Asadzadeh Aghdaei, Hamid , Bassotti, Gabrio , Bell, Phoenix , Casella, Giovanni , Ciacci, Carolina , Apostol Ciobanu, Delia Gabriela , Danciu, Mihai , Das, Prasenjit , Elli, Luca , Fasano, Alessio , Fusco, Nicola , Guandalini, Stefano , Hagen, Catherine E. , Hayman, David T S , Makharia, Govind K , Mazzarella, Giuseppe , Mohaghegh-Shalmani, Hamid , Ricci, Chiara , Rostami-Nejad, Mohammad , Taavela, Juha , Volta, Umberto , Walker, Marjorie , Drage, Michael G , Srivastava, Amitabh , Catassi, Carlo , Cross, Simon S. , SORDO, Rachele DEL , Going, James J. , Derakhshan, Mohammad Hossein
Nutrients | June 16, 2022 | Volume: 14 | Issue: 12 | Pages: 2487
Background: Histological changes induced by gluten in the duodenal mucosa of patients with non-coeliac gluten sensitivity (NCGS) are poorly defined. Objectives: To evaluate the structural and inflammatory features of NCGS compared to controls and coeliac disease (CeD) with milder enteropathy (Marsh I-II). Methods: Well-oriented biopsies of 262 control cases with normal gastroscopy and histologic findings, 261 CeD, and 175 NCGS biopsies from 9 contributing countries were examined. Villus height (VH, in μm), crypt depth (CrD, in μm), villus-to-crypt ratios (VCR), IELs (intraepithelial lymphocytes/100 enterocytes), and other relevant histological, serologic, and demographic parameters were quantified. Results: The median VH in NCGS was significantly shorter (600, IQR: 400–705) than controls (900, IQR: 667–1112) (p < 0.001). NCGS patients with Marsh I-II had similar VH and VCR to CeD [465 µm (IQR: 390–620) vs. 427 µm (IQR: 348–569, p = 0·176)]. The VCR in NCGS with Marsh 0 was lower than controls (p < 0.001). The median IEL in NCGS with Marsh 0 was higher than controls (23.0 vs. 13.7, p < 0.001). To distinguish Marsh 0 NCGS from controls, an IEL cut-off of 14 showed 79% sensitivity and 55% specificity. IEL densities in Marsh I-II NCGS and CeD groups were similar. Conclusion: NCGS duodenal mucosa exhibits distinctive changes consistent with an intestinal response to luminal antigens, even at the Marsh 0 stage of villus architecture.