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dc.contributor.authorBasu, Kaninika
dc.contributor.authorCreasey, Hannah
dc.contributor.authorBruggemann, Nina
dc.contributor.authorStevens, Jennifer
dc.contributor.authorBloxham, David
dc.contributor.authorWoodward, Jeremy Mark
dc.date.accessioned2021-04-22T12:15:04Z
dc.date.available2021-04-22T12:15:04Z
dc.date.issued2021-04-20
dc.date.submitted2021-03-06
dc.identifier.issn2041-4137
dc.identifier.otherflgastro-2021-101838
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/321436
dc.description.abstractObjective: The analysis of intraepithelial lymphocytes (IELs) by flow cytometry of duodenal biopsies—the ‘IEL’ lymphogram—has been proposed as a diagnostic test for coeliac disease. However, its clinical applicability has been limited due to variability in methods and definitions. This study set out to define useful parameters for the application of the IEL lymphogram to the diagnosis of coeliac disease. Design: Flow cytometry was performed on 117 sets of duodenal biopsies in 107 adult patients with active coeliac disease, long-term coeliac disease on a gluten free diet and a control group. The initial 95 samples were used for hypothesis generation for the subsequent samples comprising 12 patients with coeliac disease and 10 controls. Results: Rather than using single linear cut-offs for CD3 and T-cell receptor γδ (TCRγδ)+ve IELs, a discriminant function was identified as %CD3+ve IELs+2x(%TCRγδ+IELs)>100. This differentiated coeliac disease from control biopsies in the hypothesis generating group. These results were replicated in the validation group and found to be independent of histology in patients on long-term gluten free diet up to 12 years (combined sensitivity, 98.5%; specificity, 97.7%). Conclusions: Flow cytometric analysis of IELs is a highly sensitive and specific adjunct to serology and histological examination for the diagnosis of coeliac disease, even in individuals with coeliac disease following a gluten free diet who exhibit normal duodenal histology.
dc.languageen
dc.publisherBMJ Publishing Group
dc.subjectSmall bowel and nutrition
dc.subjectcoeliac disease
dc.subjectimmunology
dc.subjectgluten sensitive enteropathy
dc.subjectgluten
dc.subjectgluten free diet
dc.titleDiagnosis of coeliac disease by flow cytometry of intraepithelial lymphocytes: a new ‘gold’ standard?
dc.typeArticle
dc.date.updated2021-04-22T12:15:03Z
prism.publicationNameFrontline Gastroenterology
dc.identifier.doi10.17863/CAM.68559
dcterms.dateAccepted2021-04-08
rioxxterms.versionofrecord10.1136/flgastro-2021-101838
rioxxterms.versionVoR
dc.contributor.orcidWoodward, Jeremy Mark [0000-0002-6750-7493]
dc.identifier.eissn2041-4145


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