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OBJECTIVE: The aim of this study was to investigate the value of immunohistochemical characterization of different intraepithelial lymphocytes (IELs) in the diagnostic workup of celiac disease (CD).

METHODS: The study involved 928 consecutive adult patients undergoing endoscopy undertaken on suspicion of CD or to ascertain the dietary compliance; the control group consisted of 59 adults who underwent endoscopy because of indigestion. Small bowel mucosal morphology, CD3 , [alpha][beta] , and [gamma][delta] IELs were determined.

RESULTS: CD was detected in 138 and excluded in 545 adults. CD3 and [gamma][delta] IELs both showed a sensitivity of 93% for CD; specificity was 73% and 88%, respectively. For [alpha][beta] cells, the sensitivity was 83% and specificity, 66%. The mucosal morphology recovered on a gluten-free diet and the densities of different IELs, even [gamma][delta] cells, decreased. Only the density of [gamma][delta] cells remained elevated compared with controls.

CONCLUSIONS: Counting of IELs is recommended in borderline cases where the histology is difficult to interpret. An increase especially in [gamma][delta] cells strengthens the probability of CD. However, IELs are not invariably increased in CD.

(C) The American College of Gastroenterology 2003. All Rights Reserved.