Intraepithelial lymphocytes subsets in different forms of celiac disease

Aim The enumeration of intraepithelial lymphocytes subsets (total, gamma delta, and CD3(-) IELs) by flow cytometry (FCM), named as IEL lymphogram, constitutes a useful tool for celiac disease (CD) diagnosis. The aim of this study was to quantify IELs by FCM and their diagnostic value to differentiate active, silent and potential CD. Methods Prospective study of 60 active and 20 silent CD patients, and 161 controls in which duodenal biopsy and IEL quantification by FCM was performed. Results Active and silent CD patients had significant higher levels of both total and gamma delta IELs than absent CD patients (P < 0.0001 and P < 0.0001, P = 0.012 and P < 0.011; respectively). Active and silent CD patients had significant lower levels of CD3(-) IELs than absent CD patients (P < 0.047 and P < 0.009, respectively). Moreover, they were lower in silent than in active CD patients (P = 0.002). Changes of IELs subsets were more marked in children than adults active CD. The optimal IEL lymphogram cut off values for active CD diagnosis were: >= 10, >= 15 and <= 9 %, and with better performance characteristics for silent CD: >= 11, >= 10 and <= 5 %. Conclusion The evaluation of IELs subsets by FCM is useful to confirm diagnosis of active and silent CD.