Morphologic features suggestive of gluten sensitivity in architecturally normal duodenal biopsy specimens

We studied small bowel biopsy specimens with architecturally normal villi f rom 78 adult patients with potential gluten sensitivity (GS) and correlated them with outcome to characterize morphologic features that would allow a pathologist to suggest GS. No patient had a previous GS diagnosis. Twelve s tudy patients had GS. The mean number of intraepithelial lymphocytes (IELs) per 20 enterocytes from the tips of 5 random villi was significantly great er in GS than non-GS biopsy samples, but the groups overlapped significantl y making the number diagnostically useful only when markedly increased Cryp t mitoses counts had similar relationships. Twelve patients had an even dis tribution of IELs along villus sides and over tips (3/66 [5%] non-GS patien ts, 9/12 [75%] GS patients). Non-GS patients had a decrescendo pattern of I ELs along the sides of villi. Architecturally normal small bowel biopsy spe cimens with an appreciable, continuous, even distribution of IELs along the sides and tips of villi and a mean of 12 or more IELs in the tips of sever al villi are suggestive of GS. Pathologists should be watchful for these mo rphologic features in small bowel biopsy specimens to suggest GS.