Quantification of Duodenal Intra-Epithelial Lymphocytes

Objective: To investigate the number of intra-epithelial lymphocytes in the duodenal mucosal biopsies of patients with non specific duodenitis, clinically labelled cases of celiac disease and in normal duodenal mucosa. Material and Methods: The study included three groups. A total of 73 duodenal biopsies received in the department of histopathology, PIMS (Pakistan Institute of Medical Sciences) Islamabad, between 2008 and 2011 were placed in two groups; Group I (38 cases): Biopsy of patients with non specific duodenal symptoms, not fulfilling the clinical criteria of celiac disease and Group II (35 cases): Patients with clinical suspicion of celiac disease. Group III (20 cases) included duodenal tissue from autopsies carried out in cases of sudden death from nonGIT related causes in the department of histopathology, Armed Forces Institute of Pathology, Rawalpindi. All paraffin embedded sections were stained with Hematoxylin and Eosin and intra-epithelial lymphocytes were counted per 20 enterocytes in 5 villous tips or per 50 enterocytes in 2 villous tips (in partial villous atrophy) or per 100 enterocytes in total villous atrophy. Results: Formal counting of the index cases and controls revealed a significant difference in IELs/100 epithelial cell count between the 3 groups. The mean villous tip IEL scores were 29.9+10.7 SD (range: 10-60) in chronic non specific duodenitis, 58.19 + 24.7SD (range:16-130) in celiac disease and 15.7+2.79 SD (range:12-22) in autopsy cases. Conclusion: The results of present study suggest that 40 IELs/ 100 epithelial cells is a significant finding and should be taken as a cut-off point for celiac disease in our population.