Normal intraepithelial lymphocyte counts in duodenal biopsies and histological features of celiac disease among Jordanian adults

Abstract

Objective: The earliest histopathological feature of celiac disease (CD) is increased intraepithelial lymphocytes (IEL). The aim of this study is to find out the normal IEL count and to describe the histopathological features of CD among Jordanian population. Methods: This retrospective cohort study included 207 patients, 99 with CD cases and 108 normal controls. IEL were counted in all cases and controls. Histopathological features including villous atrophy and crypt hyperplasia were evaluated in CD cases and were classified according to the Modified Marsh classification. A two-tailed t-test was used to compare the means of variables and a P value of <0.05 was considered significant. Pearson correlation was used to measure relationships between histopathological features in CD cases. The cut-off point was suggested as the mean of normal+ 2 standard deviations (SD). Results: The mean number of IEL in normal biopsies is 11.7. The upper limit of normal is 17, this figure (17) is also the mean + 2SDs. There is no statistical difference of the number of IEL between males and females in the normal group (p = 0.54) or the CD group (p = 0.807). The number of normal IEL significantly decreases with higher age of 49 (p = 0.034). Conclusion: Using 17 as a cut-off point is sufficient to detect CD. Higher thresholds result in missing cases. The cut off points of IEL can vary among geographical areas and thresholds should take these differences into account.