From the Guidelines
Intraepithelial lymphocytes, villous atrophy, and crypt hyperplasia in the duodenum are characteristic histological findings of celiac disease, an autoimmune condition triggered by gluten ingestion in genetically susceptible individuals, as described in the most recent guidelines for monitoring established coeliac disease in adult patients 1. These histological features are a result of the immune response to gluten, which damages the small intestine, leading to malabsorption of nutrients. The presence of intraepithelial lymphocytes, villous atrophy, and crypt hyperplasia is a key diagnostic criterion for celiac disease, and is often used in conjunction with serological tests, such as tissue transglutaminase antibodies (TG2Ab) and endomysial antibodies (EMA), to confirm the diagnosis 1. The treatment for celiac disease is a strict, lifelong gluten-free diet, which allows the intestinal mucosa to heal, and patients typically experience symptom improvement within weeks of eliminating gluten, though complete histological recovery may take months to years. Some key points to consider in the diagnosis of celiac disease include:
- The presence of villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis on duodenal biopsy, as described in the Marsh and Marsh-Oberhuber score systems 1
- The use of serological tests, such as TG2Ab and EMA, to support the diagnosis 1
- The importance of HLA typing in ruling out celiac disease in uncertain cases, as nearly 100% of individuals with celiac disease exhibit the HLA-DQ2 and/or HLA-DQ8 genetic profile 1 It is also important to note that these histological features may also be seen in other conditions, such as tropical sprue, bacterial overgrowth, or medication effects, but celiac disease remains the most common cause of this specific pattern of intestinal damage. Overall, the diagnosis and management of celiac disease require a comprehensive approach, incorporating clinical evaluation, serological testing, and histological examination, as outlined in the most recent guidelines 1.
From the Research
Description of Intraepithelial Lymphocytes, Villous Atrophy, and Crypt Hyperplasia
- Intraepithelial lymphocytes, villous atrophy, and crypt hyperplasia in the duodenum are associated with several conditions, including celiac disease (CD) 2, 3, 4, 5, 6
- These histological findings can be secondary to CD or other causes such as medications, infections, or autoimmune disorders 2, 3, 4
- Increased intraepithelial lymphocytes (IELs) with normal villous architecture can be an early sign of gluten sensitivity or celiac disease 3
- Villous atrophy and crypt hyperplasia are characteristic features of celiac disease, but can also be seen in other conditions such as refractory celiac disease (RCD) 5
- The presence of these histological features can indicate a range of conditions, from gluten sensitivity to intestinal lymphoma, and require careful evaluation and diagnosis 4
Clinical Significance
- The diagnosis of celiac disease is made when there are compatible clinical features, supportive serologic markers, representative histology from the small bowel, and response to a gluten-free diet 4
- Intraepithelial lymphocytes, villous atrophy, and crypt hyperplasia can be seen in other conditions that mimic celiac disease, such as medications, infections, or autoimmune disorders 4
- A positive small-bowel capsule endoscopy (SBCE) at diagnosis can predict a worse outcome in patients with seronegative villous atrophy (SNVA) or celiac disease 2
- The severity of histology does not always correlate with mortality, and more extensive small bowel disease on SBCE is associated with poor survival 2