Patients with serological markers of coeliac disease but without features of atrophy concerning villi of the small bowel mucosa – own observations

Aim: The purpose of the study was to determine the clinical characteristics of patients with positive serological tests for coeliac disease, in whom atrophic lesions of intestinal villi of the small bowel mucosa were not found.
Material and methods: The analysis comprised 30 patients, in whom positive IgA and/or IgG anti-endomysial antibodies were detected during the period from 2002 to the present time. Simultaneously performed endoscopic biopsy of the small bowel did not reveal atrophy concerning villi of the small bowel mucosa.
Results: The group of patients included 18 females and 12 males aged from 3 to 28 years. Eight patients did not show any gastrological symptoms. Three patients suffered from type 1 diabetes mellitus, two from Duhring’s disease, one from ulcerative colitis, one from Crohn’s disease, one from cystic fibrosis, but 8 patients showed family history loaded with the presence of coeliac disease or Duhring’s disease. Recurrent abdominal pain (in 10 patients), chronic or recurrent diarrhoea (in 9 patients), alternating diarrhoea and constipation (in 1 patient), and constipation (in 2 patients) were the most often reported complaints or symptoms among symptomatic patients. Body mass deficiency occurred in 8 patients, short stature in 3 patients, enlarged abdomen circumference in 1 patient, skin lesions in 1 patient, and deficiency anaemia in 5 patients. A gluten-free diet was applied in 3 patients and clinical improvement was observed as a result. Positive anti-endomysial antibodies at least once were detected in 26 patients, using serum dilution of 1 : 20 or higher. Twenty seven patients did not reveal any histopathological lesions (M0) in a biopsy specimen of the small bowel mucosa, but 3 patients showed intraepithelial lymphocytosis without atrophic lesions of intestinal villi and without crypt hypertrophy (MI). Concerning the group of 13 patients who underwent repeated endoscopic biopsy of the small bowel from the period of time from 1 year to 4 years, 12 patients did not present progression of histopathological lesions, but lesions of type IIIC of Marsh’s classification were noted in 1 patient.
Conclusion: Patients with positive serum anti-endomysial antibodies, but without atrophic lesions of intestinal villi, need regular serological and histopathological control.