SEROLOGICAL MARKERS IDENTIFY HISTOLOGICALLY LATENT CELIAC-DISEASE AMONG FIRST-DEGREE RELATIVES

Background and aim: Serological markers detect asymptomatic coeliac di sease among first-degree relatives of patients with sprue. However, so me relatives with coeliac disease-related antibodies have 'normal' jej unal mucosa by conventional histology. Whether these serological abnor malities represent false-positives or are consequences of gluten sensi tivity is not known. Our aim was to evaluate, through quantitative his tology, intestinal biopsies of asymptomatic relatives of probands seek ing abnormalities consistent with latent coeliac disease. Materials: F ifty-nine intestinal biopsies obtained from asymptomatic relatives wer e evaluated; 40 samples were suitable for histological quantification. Seven samples showed severe mucosal atrophy (coeliac disease) and 33 were considered as 'normals'. In the 'normal' group, nine samples were obtained from patients with one or more positive serological tests an d 24 from those with negative tests. Morphometry was compared for samp les obtained from healthy control individuals (n = 10) and for those f rom coeliac patients (n = 7). Methods: Serological tests used were: an tigliadin antibodies type immunoglobulin (Ig)A and IgG (enzyme-linked immunosorbent assay), antirreticulin antibody (immuno-fluorescence) an d endomysial antibody (immunofluorescence). Biopsy samples were obtain ed with endoscopic forceps from the distal duodenum (second portion). Quantitative histology of duodenal biopsies was performed with a compu terized image analysis system. Results: Relatives with positive serolo gy showed shorter villi (P<0.05) and higher number (P<0.01) and numeri cal density (P<0.01) of intraepithelial lymphocytes in crypts than hea lthy controls. Numerical density of intraepithelial lymphocytes in cry pts in antibody-positive patients was significantly higher than that o bserved in relatives with negative serology (P<0.03). Four of nine (44 %) relatives with positive serology had a number of intraepithelial ly mphocytes in crypts within the range of coeliac disease patients. Howe ver, only one patient with negative serology (4%) was in this range. C onclusion: Our study shows quantitative histological evidence that rel atives of probands with positive coeliac disease-related serology are not false-positives, and that they should be considered as individuals with latent coeliac sprue.