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A Scoring System for Identifying Patients Likely to Be Diagnosed with Low-Grade Coeliac Enteropathy

1
Department of Gastroenterology, Hospital Universitari MutuaTerrassa, 08221 Terrassa, Barcelona, Spain
2
Centro de Investigaciones Biomédicas en Red de enfermedades hepáticas y digestivas (CIBERehd), 28029 Madrid, Spain
3
Department of Paediatrics, Hospital Universitari MutuaTerrassa, 08221 Terrassa, Barcelona, Spain
4
Department of Pathology, Hospital Universitari MutuaTerrassa, 08221 Terrassa, Barcelona, Spain
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(5), 1050; https://doi.org/10.3390/nu11051050
Received: 15 April 2019 / Revised: 26 April 2019 / Accepted: 8 May 2019 / Published: 10 May 2019
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Abstract

Background & Aims: Determining whether patients with lymphocytic enteritis (LE) have coeliac disease is a challenge. We analysed the variables associated with a low-grade coeliac enteropathy diagnosis in patients with suspected coeliac disease but without villous atrophy, and developed a scoring system to identify them. Methods: We collected data from 2010 through to 2016 on patients with lymphocytic enteritis and persistent symptoms compatible with the clinical spectrum of coeliac disease. One hundred and four patients starting on a gluten-free diet (GFD) were included. Duodenal biopsies were collected before the GFD and analysed for numbers of CD3+ T-cell receptor gamma delta+ (TCRγδ+), and CD3 intraepithelial lymphocytes. We performed a logistic regression analysis to identify factors associated with a low-grade coeliac enteropathy diagnosis. Results: Sixty-two patients achieved clinical remission after the GFD. Fifty of these 62 patients were diagnosed with low-grade coeliac enteropathy. Multivariate analysis identified the presence of >25% intraepithelial lymphocytosis, HLA-DQ2.5, positive serology, and increased numbers of TCRγδ+ cells with a low-grade coeliac enteropathy diagnosis. We developed a scoring system that identified patients with an area under the ROC curve (AUC) of 0.91. Scores of >10 had 86% sensitivity and 85% specificity. Conclusion: We developed a scoring system that identifies patients likely to be diagnosed with low-grade coeliac enteropathy with an AUC value of 0.91. View Full-Text
Keywords: prediction; response to treatment; coeliac disease; IgA anti-transglutaminase 2 deposits prediction; response to treatment; coeliac disease; IgA anti-transglutaminase 2 deposits
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Fernández-Bañares, F.; Carrasco, A.; Rosinach, M.; Arau, B.; García-Puig, R.; González, C.; Tristán, E.; Zabana, Y.; Esteve, M. A Scoring System for Identifying Patients Likely to Be Diagnosed with Low-Grade Coeliac Enteropathy. Nutrients 2019, 11, 1050.

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