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The prevalence and the causes of minimal intestinal lesions in patients complaining of symptoms suggestive of enteropathy. A follow-up study.
  1. Federico Biagi (f.biagi{at}smatteo.pv.it)
  1. Coeliac Centre/First Dept of Internal Medicine, Fondazione IRCCS Pol San Matteo, University of Pavia, Italy
    1. Paola I Bianchi
    1. Coeliac Centre/First Dept of Internal Medicine, Fondazione IRCCS Pol San Matteo, University of Pavia, Italy
      1. Jonia Campanella, Dr
      1. Coeliac Centre/First Dept of Internal Medicine, Fondazione IRCCS Pol San Matteo, University of Pavia, Italy
        1. Carla Badulli
        1. Immunohematology and Transfusion Centre, Fondazione IRCCS Pol San Matteo, Pavia, Italy
          1. Miryam Martinetti
          1. Immunohematology and Transfusion Centre, Fondazione IRCCS Pol San Matteo, Pavia, Italy
            1. Catherine Klersy
            1. Biometry and Clinical Epidemiology, Fondazione IRCCS Pol San Matteo, Pavia, Italy
              1. Costanza Alvisi
              1. Endoscopy Unit, Fondazione IRCCS Pol San Matteo, Pavia, Italy
                1. Gino R Corazza, Prof
                1. Coeliac Centre/First Dept of Internal Medicine, Fondazione IRCCS Pol San Matteo, University of Pavia, Italy

                  Abstract

                  Aims: Although they are non specific, minimal intestinal lesions are at the end of the coeliac histological damage spectrum. To investigate whether minimal intestinal lesions in patients without endomysial antibodies are due to coeliac disease, we studied not only their prevalence and causes but also their risk of evolving into frank coeliac disease.

                  Methods: From Jan-2000 to Dec-2005, 645 duodenal biopsies were performed. In 209 patients, duodenal biopsies were performed independently of endomysial antibody results. Clinical data and HLA-typing of all the patients negative to endomysial antibodies but with minimal mucosal lesions were re-evaluated. Three years later, they were offered to be seen again and further investigations were proposed.

                  Results: 14 out of 209 patients had minimal mucosal lesions and negative endomysial antibodies. Two patients were lost to follow-up; in 7/12 patients, symptoms and histological lesions were due to a different condition, not related to coeliac disease. In 11/12 patients, HLA-typing made diagnosis of coeliac disease very unlikely. Only one patient was on a gluten-free diet because of gluten-sensitive symptoms and was DQ2+/DQ8+.

                  Conclusions: Minimal duodenal lesions in patients negative to endomysial antibodies are rare and are likely to be due to conditions unrelated to coeliac disease.

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