Spectrum of gluten-sensitive enteropathy in patients with dysmotility-like dyspepsia

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• 作者：Santos Santolaria^a ; ^{ssantolariap@indogastro.org} ; Javier Alcedo^a ; Berta Cuartero^a ; Irene Diez^a ; Manuel Abascal^b ; Mª ; Dolores Garc&#237 ; a-Prats^b ; Miguel Marigil^b ; Jesú ; s Vera^b ; Margarita Ferrer^c ; Miguel Montoro^a
• 关键词：Dyspepsia ; Gluten-sensitive enteropathy ; Gluten-sensitivity ; Lymphocytic enteropathy ; Duodenal biopsies ; Gluten-free diet
• 刊名：Gastroenterolog¨ªa y Hepatolog¨ªa
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：36
• 期：1
• 页码：11-20
• 全文大小：340 K

文摘

Background

Dysmotility-like dyspepsia symptoms are frequent in patients with gluten-sensitive enteropathy (GSE). Current data suggest that patients with mild enteropathy may be present with gluten-sensitive symptoms and complications.

Aim

To investigate the prevalence of GSE, including mild enteropathy, in patients with dysmotility-like dyspepsia symptoms.

Methods

We retrospectively studied 142 patients who presented dysmotility-like dyspepsia symptoms and normal upper gastrointestinal endoscopy. Endoscopic duodenal biopsies were taken and processed using hematoxylin-eosin staining and CD3 immunophenotyping. In patients with enteropathy (number of intraepithelial lymphocytes greater than 25 per 100 enterocytes) we also performed coeliac serology (anti-tissue transglutaminase IgA) and HLA-DQ2/DQ8 genotyping. A gluten-free diet was offered if one of these markers was positive. The final GSE diagnosis was established based on clinical and histopathological response to the gluten-free diet after 18 months of follow-up.

Results

Fifty-one patients (35.9 % ) had enteropathy; 4 (2.8 % ) Marsh type 3b, 24 (16.9 % ) Marsh type 3a, 3 (2.1 % ) Marsh type 2, and 20 (14.1 % ) Marsh type 1. A positive serology result was extremely low (6.7 % ) in mild enteropathy (Marsh type 1-3a) in contrast with Marsh type 3b patients (50 % ). Most patients with enteropathy had positive HLA DQ2 or -DQ8 genotyping (84.1 % ). Out of the 37 patients who started a gluten-free diet, 34 (91.9 % ) improved their symptoms, and 28 of 32 (87.5 % ) had a histopathological or serological response. A final GSE diagnosis was established in 28 of the 142 patients (19.7 % ).

Conclusion

Gluten-sensitive enteropathy can be a frequent and unsuspected cause of dysmotility-like dyspepsia.