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Open Access 01-12-2019 | Celiac Disease | Research

An association between crypt apoptotic bodies and mucosal flattening in celiac disease patients exposed to dietary gluten

Authors: Michael Lee, Shane Betman, Alina Iuga, Hui-Min Yang, Jude Fleming, Peter H. R. Green, Benjamin Lebwohl, Stephen M. Lagana

Published in: Diagnostic Pathology | Issue 1/2019

Abstract

Background

Celiac disease (CD) is characterized histologically by inflammation and villous atrophy. Villous atrophy is thought to result from a disruption of epithelial cellular proliferation and death. Epithelial cells in intestinal mucosa normally proliferate in the crypts and migrate towards the lumen, eventually dying. Apoptotic bodies in crypts are usually abnormal and are associated with certain disease states. The presence of crypt apoptosis in celiac disease has not been thoroughly examined by routine histologic assessment of crypt apoptotic body count (ABC).

Methods

We quantified the ABC in duodenal biopsies from celiac patients before and after initiation of a gluten-free diet (GFD). We examined twenty-three duodenal biopsies from adult patients with celiac disease at diagnosis and following GFD and determined the maximum ABC in 10 consecutive crypts. Fourteen biopsies from heartburn patients served as controls.

Results

Mean duration between paired biopsies was 2.9 (0.5–8.5) years. Mean maximum ABC in active celiac disease was 5.44 per crypt and decreased to 2.60 with GFD (p = <.0001). The mean maximum ABC in controls was 1.79, lower than both active celiac disease and GFD (p = <.0001 and p = .019 respectively). Flat lesions with total villous atrophy (mean: 6.44) showed a higher ABC compared to non-flat lesions (mean: 4.87); p = .04.

Conclusions

Crypt ABC is markedly elevated in active celiac disease and decreases significantly with GFD, however it does not achieve normalcy. Total villous atrophy is associated with a higher ABC than all other lesions. Crypt apoptosis is likely a significant contributor to villous atrophy in celiac disease and can be appreciated by routine histologic examination.

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Title: An association between crypt apoptotic bodies and mucosal flattening in celiac disease patients exposed to dietary gluten
Authors: Michael Lee
Shane Betman
Alina Iuga
Hui-Min Yang
Jude Fleming
Peter H. R. Green
Benjamin Lebwohl
Stephen M. Lagana
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Celiac Disease
Celiac Disease
Published in: Diagnostic Pathology / Issue 1/2019
Electronic ISSN: 1746-1596
DOI: https://doi.org/10.1186/s13000-019-0878-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

An association between crypt apoptotic bodies and mucosal flattening in celiac disease patients exposed to dietary gluten

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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