Genetic, morphometric and immunohistochemical markers of latent coeliac disease

Background It is recognized that coeliac disease may exist in a latent form characterized by HLA-DR3 and increased counts of intra-epithelial lymphocy tes (IELs) and gamma/delta T cells in jejunal biopsies. Aims To determine whether subjects with persistent serological markers 4 an d 13 years after a population screening survey have the HLA constitution of coeliac disease and/or minor morphometric abnormalities of the small intes tine, including raised gamma/delta T-cell counts, as possible indicators of latent coeliac disease. Subjects Participants with positive serology detected by the Belfast MONICA Project surveys (1983 and 1991) were subdivided into those with persistent ly positive serology (persistent serology), negative serology at follow-up (transient serology) and those with enteropathy (coeliac disease). Morphome tric features were compared with MONICA controls who had negative serology and HLA antigen frequencies were compared with blood donor controls. Methods Subjects were followed up in 1994-1996 and were re-tested for IgA a ntibodies to gliadin, endomysium and reticulin. HLA typing was carried out and IELs and gamma/delta T-cell counts were assessed in jejunal biopsies in subjects who gave consent. Results Persistent serology mainly concerned antigliadin (AGA) and antireti culin (ARA) antibodies but one patient had positive antiendomysial antibody (EMA) and ARA in 1983, which became negative at follow-up, at which time t hey were positive for AGA, No significant differences were observed between IELs or gamma/delta T-cell counts when the persistent and transient groups were compared in turn with the MONICA controls. HLA-DR2 was expressed in 1 1 of 16 in the persistent group compared to 47 of 150 blood donor controls (P = 0.013). HLA-DR3 occurred in 15 of 17 coeliac patients compared to 37 o f 150 blood donors (P = 0.00001). Conclusions Persistent serological markers following population screening d o not appear to indicate latent coeliac disease. Eur J Gastroenterol Hepato l 11:1283-1288 (C) 1999 Lippincott Williams & Wilkins.