Poster (15W170)

Clinical outcome of patients with raised intraepithelial lymphocytes (IELs) with normal villous architecture on small intestine biopsy

Author(s)

Vikrant Parihar*, Roisin Stack*, A. Alakari*, Stephen Crowther**, Deirdre McNamara*

Department(s)/Institutions

Departments of *Gastroenterology & **Histopathology;Tallaght Hospital

Introduction

Intraepithelial lymphocytes (IELs) are a population of T-lymphocytes present between epithelial cells of both small and large bowel. Raised IELs with preserved villi are a feature of latent coeliac disease (CD). However they are also seen in a number of other conditions and the interpretation and the management of patients with high IEL’s remains challenging. Follow-up data from clinical practice may help identify at risk patients.

Aims/Background

Assess the clinical presentation, demographic profile and clinical outcome in a cohort of patients with increased IELs on small intestinal biopsy.

Method

The histopathology database at Tallaght Hospital was interrogated to identify patients from 2013 and 14 where at least one duodenal or jejunal biopsy had increased numbers of IELs (duodenal >25 and jejunum > 40 IELs/100 enterocytes) with preserved villous architecture. Patients were excluded if any biopsy showed architectural change. A retrospective review of medical notes was then undertaken and demographic and clinical data was recorded and compared according to outcome.

Results

To date 94 patients have been identified. Follow up data is available for 40 (43%), 16(40%) males, mean age 44 years (range 20-81) and mean follow-up 17.3 months (range7-36). Presentations included microcytic anaemia (n= 12, 30 %), abdominal pain (n=9, 23 %), reflux (n=7, 18%) diarrhoea (n= 4, 10%), other (n=8, 20%). None were on medications associated with raised IEL’s. Overall 4 (10%) gave a history of autoimmune conditions. On follow up 9 (23%) patients have been given a clinical diagnosis of CD and commenced on a gluten free diet. Interestingly only one had repeat small bowel biopsies. Associated conditions, medications and indication were not predictive of CD development. Of note 8/9 (89%) that developed CD were women, OR 7.5 p<0.05, 95%CI 0.74-0.01. CD patients were older 55 versus 41 years, p< 0.04, 95%CI 26.8- 0.28. In addition 6/9 (66%) with CD had a raised tTG titer at presentation versus 0/21 without, OR 7.9, p< 0.0001, 95%CI 0.45-0.88. H. pylori tests were available in 32 cases, 11(35%) were positive. There was a negative association between H.pylori infection and subsequent CD development, 1 of 9(11%) CD versus 10 of 23 (43%) without CD, OR 0.16, p<0.04.

Conclusions

Bearing in mind the limitations, our study suggest older women with increased IEL’s have a higher conversion to CD. Anaemia and raised tTG at presentation warrants close follow up, while H. pylori infection is commonly associated with raised IEL’s without latent coeliac disease.