The significance of intraepithelial lymfocytosis without villous atrophy for the diagnosis of celiac disease.

Celiac disease is a small bowel disorder that occurs upon exposure to gluten
and is characterized by abdominal symptoms and malabsorption and long term
complications like infertility, osteoporosis and small bowel malignancies.
There is a strong association between celiac disease and HLA DQ2 and/or DQ8.
The absence of HLA DQ2 or DQ8 virtually excludes celiac disase. The
histological abnormalities associated with celiac disease are classified
according to Marsh. Marsh 1 denotes an increased number of intraepithelial
lymfocytes without villous atrophy. Intraepitehial lymfocytosis without villous
atrophy is also observed in other small bowel disorders. As the absence of HLA
DQ2 or DQ8 excludes celiac disease in patients with Marsh 1 in duodenal biopsy
specimens we hypothesized that the prevalence of HLA DQ2 or DQ8 is
significantly higher in pateints with intraepithelial lymfocytosis only as
compared to the general population if this condition is associated with celiac
disease.

To study the prevalence of HLA DQ2 or DQ8 gene locus and celiac disease in
patients in which previously idiopathic intraepithelial lymfocytosis without
villous atrophy was found.

Patients with intraepithelial lymfocytosis without villous atrophy will be
included. Patients will be asked about abdominal symptoms or signs consistent
with celiac disease. Patient will also be checked for symptoms suggestive of
irritable bowel syndrome according to the Rome III criteria. Additinally,
patients will be asked to fill out a quality of life questionnaire (RAND-36).
Finally, in all included patients 10 ml of blood will be drawn to analyse HLA
DQ2 or DQ8, anti-endomysium antibodies and anti-tissue transglutaminase
antibodies.

A minimal burden consisting of filling out questionnaires and drawing 10 ml of
blood once.