Duodenal Intraepithelial Lymphocytosis with Normal Villous Architecture: An Association with Inflammatory Bowel Disease?
Emily R Patterson, Eugenia Shmidt, Amy S Oxentenko, Thomas C Smyrk. Mayo Clinic, Rochester, MN
Background: Duodenal intraepithelial lymphocytosis (IEL) with normal villous architecture is a non-specific finding; celiac disease, H. pylori gastritis, small intestinal bacterial overgrowth and non-steroidal anti-inflammatory drug (NSAID) injury are among the top etiologic considerations. Some studies have implicated inflammatory bowel disease (IBD) as a cause of duodenal IEL, but current summaries list neither Crohn's disease (CD) nor ulcerative colitis (UC) among the differential diagnoses. Our aim was to study the association of duodenal IEL with normal villous architecture in patients with IBD.
Design: We reviewed the Mayo Clinic pathology database for all duodenal biopsies revealing IEL with normal villous architecture from 2000-2010. Among 1154 patients with this histologic finding, 74 had IBD. Duodenal biopsies and medical records were reviewed to confirm the IEL finding, establish the clinical diagnosis and document concurrent medications. In addition, we reviewed all upper gastrointestinal biopsies obtained from our study patients.
Results: Of the 74 patients with isolated duodenal IEL, 13 had UC, 58 had CD, and 3 had indeterminate colitis. At the time of index biopsy, 15 patients were on NSAIDs (11 CD; 4 UC), 4 had H. pylori gastritis, 3 had systemic autoimmune disease, and 1 had documented celiac disease. Gastric biopsies from patients with UC or indeterminate colitis (n = 7) were non-descript (i.e, chronic gastritis, reactive gastropathy). Among patients with CD, 10/34 had active chronic gastritis (4 positive for H. pylori) and 16/34 had focally enhanced gastritis (only 2 of these were on NSAIDs). Esophageal biopsy findings from 10 patients were non-specific, except for granulomatous esophagitis in one patient with CD.
Conclusions: Duodenal IEL with normal villous architecture can be seen in patients with IBD in the absence of other conditions associated with this histologic finding. While duodenal IEL and focally enhanced gastritis are each non-specific findings, the combination of the two is suggestive of CD. Duodenal IEL is less common in patients with UC, and does not appear to be associated with specific gastric pathology.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 110, Monday Morning