Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 573-589
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.573
Intraepithelial lymphocytes, scores, mimickers and challenges in diagnosing gluten-sensitive enteropathy (celiac disease)
Consolato Sergi, Fan Shen, Gerd Bouma
Consolato Sergi, TianYou Hospital, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China
Consolato Sergi, Fan Shen, Departments of Laboratory Medicine and Pathology, University of Alberta, Edmonton AB T6G 2B7, Canada
Gerd Bouma, Department of Gastroenterology and Hepatology, Vrije Universiteit Medical Center, 1081 HV Amsterdam, The Netherlands
Author contributions: Shen F contributed to the study conception and design; Sergi C performed the collection of data, their analysis and interpretation, drafting the manuscript with statistical analysis; Sergi C, Shen F and Bouma G revised the final draft of the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Consolato Sergi, MSc, MD, PhD, FRCPC, Professor, Departments of Laboratory Medicine and Pathology, University of Alberta, 8440 112 St, Edmonton AB T6G 2B7, Canada.
Telephone: +1-780-4077951 Fax: + 1-780-4073009
Received: September 1, 2016
Peer-review started: September 2, 2016
First decision: September 21, 2016
Revised: October 27, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: January 28, 2017

The upper digestive tract is routinely scoped for several causes of malabsorption, and the number of duodenal biopsy specimens has increased notably in the last 10 years. Gluten-sensitive enteropathy (GSE) is an autoimmune disease, which shows an increasing prevalence worldwide and requires a joint clinico-pathological approach. The classical histopathology of GSE with partial or total villous blunting is well recognized, but the classification of GSE is not straightforward. Moreover, several mimickers of GSE with intraepithelial lymphocytosis have been identified in the last 20 years, with drug interactions and medical comorbidities adding to the conundrum. In this review, we report on the normal duodenal mucosa, the clinical presentation and laboratory diagnosis of GSE, the duodenal intraepithelial lymphocytes and immunophenotype of GSE-associated lymphocytes, the GSE mimickers, the differences “across oceans” among guidelines in diagnosing GSE, and the use of a synoptic report for reporting duodenal biopsies in both children and adults in the 21st century.

Keywords: Gluten, Duodenum, Lymphocytes

Core tip: Striking and unique microphotographs with comparison of classification of gluten-sensitive enteropathy across oceans and tables useful for the practice of gastroenterology.