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Abstract D Weiss Background--Clonal T cell receptor (TCR) gene rearrangements and loss of T cell antigens such as CD8 and TCR-β in intraepithelial lymphocytes (IELs) may indicate the development of [...]

Celiac disease is an intestinal malabsorption syndrome characterized by intestinal bleeding, diarrhea, malnutrition, and disordered calcium metabolism. This condition is caused, at least in part, by a hypersensitivity to dietary gluten (a protein found in wheat). Celiac disease has been reported to have a higher prevalence and to occur in a latent form in patients with herpetiform dermatitis (an inflammatory disease of the skin); both of these conditions have been linked to disorders of the immune system. It has been reported that increased levels of a particular subclass of immune cell (T lymphocytes which express the gamma/delta receptor molecule) may be a diagnostic marker for the presence of both latent and overt celiac disease. A case (the first such documented case) is described of a 35-year-old man who was studied because of an abnormality in blood chemistry (low serum titer of reticulin antibody) and because of the presence of overt celiac disease in his son. (The patient had been diagnosed with epilepsy, and suffered infrequent seizures; this was not thought to be related to the variables assessed in this case.) Intestinal biopsy revealed completely normal anatomy of the small intestine, and celiac disease would have been ruled out on this basis alone. Total lymphocyte level was normal in the biopsy specimen, but the number of cells expressing the gamma/delta T cell receptor was 10 times that found in normal subjects. Two years later, a subsequent intestinal biopsy specimen was taken because of celiac disease symptom onset; microscopic anatomy was consistent with a diagnosis of celiac disease. A biopsy taken during a period in which the patient was on a gluten-free diet showed normal intestinal anatomy, but continued elevation of gamma/delta T cell receptor-positive lymphocytes. (Consumer Summary produced by Reliance Medical Information, Inc.)

As European and North American societies become more opulent, the focus of attention moves inevitably from diagnosis and treatment of diseases to screening of populations. Successful screening would require an [...]

Coeliac disease (CD) is an immune mediated enteropathy triggered by ingestion of gluten containing grains in genetically susceptible individuals. (1) CD is associated with HLA alleles DQ2 and/or DQ8, and [...]

The cellobiose/mannitol sugar test is a non-surgical method for measuring the permeability of the intestines. A drop in the absorption of small molecules and a rise in the absorption of large molecules occurs during coeliac disease. Two forms of sugar, cellobiose, a disaccharide, and mannitol, a sugar alcohol, when administered at the same time, allow the permeability of small bowel mucous membranes to be studied, and keep other factors such as gastric emptying and incomplete urine collection from influencing the results of the test. Taking into account patients who had jejunal biopsies, the test's sensitivity for coeliac disease is 96 percent, its specificity 70 percent, the predictive value of the positive is 36 percent and the predictive value of the negative 99 percent.