A reassessment of splenic hypofunction in celiac disease

Objectives: Because there is controversy regarding the prevalence, familial occurrence, and possible factors inducing splenic hypofunction in celiac d isease, we have reassessed them in a large series of untreated patients and their first-degree relatives. Methods: Fitted red cell counting was used t o measure splenic function and the effect that age at diagnosis has on it, while severity of intestinal lesions and nutritional status were estimated by multiple linear regression analysis. Moreover, serum tuftsin activity wa s assayed by measuring its ability to stimulate phagocytosis of opsonized S taphylococcus aureus. Results: We found that 32.8% of untreated celiacs and none of their relatives had pitted red cell values in the range of splenic hypofunction (>4%), Only age at diagnosis, but not the other two covariate s, was significantly associated with the degree of splenic hypofunction, Tu ftsin activity was depressed in celiac disease and this reduction was signi ficantly greater in hyposplenic patients. Conclusions: In celiac disease th e prevalence of splenic hypofunction is lower than formerly believed. The d uration of preexposure to gluten is a crucial factor for the prevalence and severity of this complication that does not affect celiac relatives. In ce liac disease splenic hypofunction is accompanied by a reduced phagocyte act ivity linked to the decreased release of tuftsin, (Am J Gastroenterol 1999; 94:391-397, (C) 1999 by Am. Cell. of Gastroenterology).