Introduction Lymphocytic duodenosis (LD) is a histological diagnosis comprising normal duodenal architecture, but an intraepithelial lymphocyte (IELs) count >25/100 enterocytes. A diagnosis of coeliac disease (CD) can be made in up to 16% of cases where LD is seen.1 CD serology (antibodies to tissue transglutaminase) should be performed in all cases of LD. The aim of this study was to identify the rate of CD serological investigations following a diagnosis of LD.
Methods All duodenal biopsies taken at St Marys Hospital, London between March and August 2011 were evaluated. The histological reports for all duodenal biopsies coded as abnormal were reviewed. Serology results were checked in all cases where LD was diagnosed.
Results 280 duodenal biopsies were performed of which 24 met the criteria for a diagnosis of LD (8.6%). The indication for biopsy was anaemia in 12/24 (50%), dyspepsia in 4/24 (16.7%), abdominal pain in 3/24 (12.5%), dysphagia in 1/24 (4.2%) and an indication was not indicated in 1/24 (4.2%). The numbers of lymphocytes per 100 enterocytes varied from 26 to 62. Serological testing for CD was carried out prior to or following the diagnosis of LD in 12/24 (50%). In all cases where serology was performed the result was negative.
Conclusion Opportunities to diagnose CD are being missed in 50% of cases. These figures are similar to an audit carried out in the same department in 2009 which showed that serological testing for CD was being carried out in 56% of cases where LD was diagnosed. Diagnosis and treatment of CD has been shown to reduce morbidity and mortality2 3 and reduce the cost of medical care.4 Therefore it is important that opportunities to diagnose CD are taken and follow-up on the diagnosis of LD with serological testing by clinicians is imperative.
Competing interests None declared.
References 1. Aziz I, Evans KE, Hopper AD, et al. A prospective study into the aetiology of lymphocytic duodenosis. Aliment Pharmacol Ther 2010;32:1392–7.
2. Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed coeliac disease. Gastroenterology 2009;137:88–93.
3. Godfrey JD, Brantner TL, Brinjikji W, et al. Morbidity and mortality among older individuals with undiagnosed coeliac disease. Gastroenterology 2010;139:763–9.
4. Long KH, Rubio-Tapia A, Wagie AE, et al. The economics of celiac disease: a population-based study. Aliment Pharmacol Ther 2010;32:261–9.
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