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    • Clinical Data Do Not Reliably Predict Duodenal Histology at Follow-up in Celiac Disease: A 13 Center Correlative Study.

    Angiologia e Cirurgia Vascular（2023）SCI 1区

    Yale Sch Med | Beth Israel Deaconess Med Ctr | St Antonius Hosp | Univ Amsterdam | Fdn IRCCS Ca Granda Osped Maggiore Policlin Milan | Boston Childrens Hosp | Seattle Childrens Hosp | Friedrich Alexander Univ Erlangen Nuremberg | Mayo Clin | Univ Chicago | UCLA | Univ Calif San Francisco | Univ Michigan | Univ Texas Southwestern Med Ctr | Univ Utah | Yale Univ

    Cited 3|Views17
    Abstract
    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.
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    celiac disease,Marsh score,intraepithelial lymphocytes,duodenum,tissue transglutaminase
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    【要点】：该研究通过13中心协作，发现临床数据不能可靠预测乳糜泻患者随访时的十二指肠组织学变化，指出病理学恢复与临床症状、抗体滴度和无麸质饮食依从性无相关性，强调了病理学评估在患者管理中的重要性。
    

    【方法】：研究采用盲法评估了181例乳糜泻患者初始和随访时的十二指肠活检样本，使用Marsh评分和每100个肠上皮细胞的 intraepithelial lymphocytes (IELs)作为评估指标。
    

    【实验】：在13个中心进行的随访活检显示，31%的患者存在持续绒毛平坦，25%的患者IELs持续升高，仅有44%的患者实现了完全的组织学缓解。IELs的正常化滞后于绒毛的恢复，且研究发现儿童比成人在Marsh评分和IELs恢复上表现出更好的恢复（P <0.001和P <0.01）。研究中使用的数据集为患者活检病理数据。