Clinical expression of lymphocytic duodenosis in "mild enteropathy" celiac disease and in functional gastrointestinal syndromes

Objective. Abnormally high number of duodenal intraepithelial lymphocytes is frequently found in many conditions including
mild enteropathy celiac disease (CD) and functional gastrointestinal syndromes, but is unclear whether lymphocytosis affects
the clinical phenotype particularly in functional syndromes. Materials and methods. We compared clinical characteristics of
celiac patients with lymphocytic duodenosis and normal villous structure with those of patients with functional gastrointestinal
syndromes with and without lymphocytic duodenosis. We retrospectively identified 3 cohorts among patients referred for
suspected CD: (1) “CoelD”, 135 patients (age 36 ± 14 years) with mild enteropathy CD; (2) “LymD”, 245 patients (38 ±
12 years) with functional gastrointestinal syndromes and lymphocytic duodenosis; and (3) “NorD”, 147 patients (37 ±
15 years) with functional syndromes and normal duodenal histology. Results. Prevalence of gastrointestinal symptoms was
similar in the three cohorts, but prevalence of extra-intestinal manifestations (42% vs. 27% vs. 18%, p < 0.003) and of
associated diseases (35% vs. 15% vs. 14%, p < 0.0001) was higher in “CoelD” than in “LymD” and “NorD”, respectively.
Prevalence of Helicobacter pylori infection was similar in the three cohorts. The proportion of patients with final diagnosis of
irritable bowel syndrome-diarrhea (38% vs. 37%), dyspepsia (31% vs. 27%), functional pain (14% vs. 19%), and functional
diarrhoea (14% vs. 11%) was virtually the same in the cohorts with (LymD) and without (NorD) lymphocytic duodenosis.
Conclusions. Lymphocytic duodenosis has different clinical presentation in patients with mild enteropathy CD than those
with functional gastrointestinal syndromes, and is not specific for any particular functional syndrome.