Celiac disease without villous atrophy - Revision of criteria called for

Current diagnostic criteria of celiac disease require small bowel villous a trophy, although the damage develops gradually. We therefore searched for e vidence of disease in 10 adults suspected to have celiac disease, but evinc ing only minor mucosal inflammation and increase in gamma delta (+) cells w ithout villous atrophy. Twenty untreated celiac and 27 nonceliac patients s erved as biopsy controls. CD3+, alpha beta (+), and gamma delta (+) cells w ere increased in patients with only minor mucosal lesions, but less than in celiac patients. The inflammation resolved on gluten-free diet, and abdomi nal symptoms were alleviated. Eight of 10 had positive endomysial, seven gl iadin, and nine tissue transglutaminase antibodies; all normalized on diet. Eight patients had osteopenia; HLA DQ2 was found in all. Minor mucosal les ions with an increase in gamma delta (+) intraepithelial lymphocytes were s uggestive of celiac disease. Our patients showed a clinical, histological, and serological recovery on diet; risk of osteopenia speaks in favor of die tary treatment.