GLUTEN-SENSITIVE DISEASE WITH MILD ENTEROPATHY

Background & Aims: Celiac disease is a permanent gluten intolerance st rongly associated with HLA class II antigens and possibly showing mild er changes of mucosal architecture, Ten patients with symptoms suggest ing celiac disease and serum antiendomysium antibodies with normal muc osal architecture were studied. Methods: Immunohistochemical detection of mucosal immune activation and HLA typings were performed. Results, Mucosal immune activation, with normal mucosal architecture and norma l gamma/delta(+) intraepithelial lymphocytes counts, was found on a gl uten-containing diet. In 3 of 6 patients, multiple biopsy specimens sh owed one sample with severe villous atrophy, Clinical and immunomorpho logic features were strictly gluten dependent. The mucosal immune acti vation was elicited in vitro by gliadin, Only 4 patients had the typic al HLA typing of celiac disease. Conclusions: Gluten-sensitive celiac- like symptoms may occur in patients with serum antiendomysium antibodi es, apparently normal intestinal mucosa, and HL4 typing not commonly a ssociated with celiac disease, These patients should undergo multiple biopsies, and signs of immunologic activation should be sought accurat ely; in the presence of mucosal immune activation, a trial with a glut en-free diet should be encouraged to detect gluten dependency, In vitr o immunologic response of small intestinal mucosa to gliadin may suppo rt the diagnosis of gluten-sensitive enteropathy.