Introduction Lymphocytic duodenosis (LD) is defined by normal villous architecture and intraepithelial lymphocytes (IELs) > 25 per 100 enterocytes. Such patients should not be diagnosed with coeliac disease (CD), solely by histology, as recent studies have suggested other associations with LD. Despite a paucity of data, previous investigators have suggested that LD may also be associated with irritable bowel syndrome (IBS).
AimsTo prospectively assess the associations between LD and IBS.
Methods Two hundred patients with LD were investigated for associated LD conditions, by means of revisiting the patient’s history and recent investigations including the initial coeliac serology, followed by a combination of gluten challenge, HLA typing, repeat duodenal biopsies, and exclusion of infection/inflammatory bowel disease.
A diagnosis of CD was based on the persistence or progression of LD on a gluten-containing diet, the presence of HLA DQ2 or DQ8, and a clinical response to a gluten free diet.
In the absence of an alternative cause, a diagnosis of IBS was made on the presence of the ROME III criteria.
Results 150 female, 50 male, mean age 49, SD 16, age range 17–83
An identifiable association was found in 70% of patients : CD (20%), NSAIDs (17%) and H.pylori (16%) accounting for the majority. Other causes included gastrointestinal infections (7%), autoimmune disorders (5.5%), inflammatory bowel disease (2%), TB or HIV (1.5%), and IgA deficiency (1%).
In 60 cases (30%) no cause was found, although reassuringly two-thirds normalised their histology. In just over half of those without an identifiable cause, symptoms were consistent with IBS (35/60). IBS, therefore, accounted for 17% of all LD cases.
Whereas all patients with CD were HLA positive, only 55% of those with alternative causes or IBS were HLA positive (p < 0.0001).
Conclusion 17% of LD is associated with the Rome III criteria for IBS. LD may, therefore, be a disease marker for IBS and a reflection of low grade inflammatory response although no clues to the triggering mechanism were elucidated.
Disclosure of Interest None Declared
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