Ashish Chauhan1, Prasenjit Das2, Alka Singh1, Rimlee Dutta2, Madhu Rajeshwari2, Mahendra Singh Rajput1, Ashish Agrawal1, Vikas Banyal1, Srikant Mohta1,Ashish Upadhay3, Vineet Ahuja1, Govind Makharia1

1Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, 3Department of Biostatistics, All India Institute of Medical Sciences, New Delhi

Background/Aims: While celiac disease (CeD) is considered to affect primarily the small intestine, pathological changes of other parts of the gastrointestinal tract (GIT) are also known. However, there is no established method to diagnose the extra-intestinal pathologies in CeD. IgA anti-tissue transglutaminase 2 antibody (anti-TG2 Ab) deposits at the site of involvement are evolving as one of the methods to establish CeD-related tissue pathology.

Methods: Forty-two treatment-naive patients with CeD and 45 patients with irritable bowel syndrome were included as cases and controls, respectively. They underwent esophagogastroduodenoscopy and sigmoidoscopy, and mucosal biopsies were collected from the esophagus (lower, mid, and upper), stomach (as per Sydney protocol), duodenum (bulb and post ampullary), and rectosigmoid regions, both at baseline and 6-month post-gluten free diet (GFD). All biopsies were evaluated for histological changes and subjected to dual-color immunohistochemical staining for identifying IgA anti-TG2 antibody (Ab) deposits, as evidence of CeD-related pathological changes at these sites.

Results: Significantly higher number of patients with CeD had lymphocytic esophagitis (9.7% vs 0%, P= 0.05), lymphocytic gastritis (35% vs 8.8%, P<0.01) and lymphocytic colitis (17.4% vs 0%, P<0.05) than that in controls. Anti-TG2 Ab deposits were observed at the esophagus (30.9% vs 6%, P<0.001), stomach (62.2% vs 9.3%, P<0.01), duodenum (88.5% vs 0%, P<0.001) and rectal (17.4% vs 0%, P<0.05) biopsies from patients with CeD showing mucosal pathological changes, than in controls. On follow-up, there was a decline in the lymphocytosis and also the intensity of anti-TG2 Ab deposits, though this change was not statistically significant.

Conclusion: A significantly higher number of patients with CeD had evidence of lymphocytic esophagitis, lymphocytic gastritis, and lymphocytic colitis than in controls. Also, anti-TG2 Ab deposits were significantly higher in these patients showing mucosal lymphocytosis than in controls, suggesting CeD-related changes at these sites.

Keywords: Celiac disease, gastrointestinal tract, esophagus, stomach, lymphocytosis