Neutrophilic Infiltration in Gluten Sensitive Enteropathy (GSE): A Series of 100 Pediatric Patients
OK Kolman, I Brown, CJ Moran, GJ Russell, M Mino-Kenudson. Massachusetts General Hospital and Harvard Medical School, Boston, MA; Sullivan Nicolaides Pathology, Taringa, Australia
Background: While several small studies postulate that neutrophils constitute a part of the duodenal inflammatory infiltrate in GSE, neutrophils are commonly seen in other duodenal pathology, such as peptic injury, and may complicate the diagnosis of GSE. To define the spectrum of neutrophilic activity in GSE, we reviewed a series of 100 pediatric patients with GSE, the largest in the literature to date.
Design: 114 duodenal and 100 antral biopsies obtained as part of initial assessment for GSE of 100 patients with positive Celiac serology and symptomatic response to a gluten-free diet were semiquantitatively evaluated for histologic parameters of disease activity [intraepithelial lymphocytes per 100 enterocytes (IEL), lymphoplasmacytic infiltration of the lamina propria (LPI), crypt hyperplasia and villous blunting combined as “disease activity score”(DAS: 0-12)], neutrophilic activity [lamina propria infiltration, surface exocytosis, and cryptitis, combined as “neutrophilic activity score”(NAS: 0-6)], eosinophilic infiltration (0-3), foveolar metaplasia (0-2), and Brunner gland hyperplasia (BGH; 0-1). Antral biopsies were evaluated for the presence and type of gastritis.
Results: The patients were 63% female with average age of 9.3 years (range: 1.5-20). 28% of patients had mild and 59% moderate villous blunting, with mean IEL of 67 (range 10-140). 78% showed neutrophilic infiltration, with neutrophilic exocytosis in 47%, and cryptitis in 20%. In multivariate analysis, NAS correlated inversely with age (p= .003) and positively with the DAS (p=.004), but correlation with IEL (p=.10) and eosinophilic infiltration (p=.09) were not significant. Mean age of low NAS (45% of patients, score: 0-1) was 11.0, while mean age of high NAS (55%, score: 2-5) was 7.9 (p=.002). In univariate analysis, NAS correlated with the presence of H. pylori negative lymphocytic gastritis (18% of patients, p=.002). NAS showed no significant relationship to presence of foveolar metaplasia (11% of patients, p=.28) or BGH (16%, p=.36).
Conclusions: Our study shows that neutrophilic infiltration is not uncommon in duodenal biopsies of patients with GSE, correlates with the overall disease activity, and is more frequently seen in younger patients. Thus, prominent duodenal neutrophilic infiltration is not diagnostic of superimposed peptic injury or other entities, especially in young children with clinical findings supportive of GSE.
Monday, March 22, 2010 1:00 PM
Poster Session II # 81, Monday Afternoon