BACKGROUND The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. AIM To evaluate the accuracy of both an increase in CD3+ T-cell receptor gamma delta+ (TCRγδ+ ) intraepithelial lymphocytes and coeliac lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. METHODS Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3- by flow cytometry were performed at the index endoscopy. Coeliac lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3- intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. RESULTS Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac lymphogram, and 70% and 4% for positive and negative TCRγδ+ . CONCLUSIONS Coeliac lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.

中文翻译：

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血清阴性绒毛萎缩患者的乳糜泻诊断方法为γ-δ+上皮内淋巴细胞和乳糜泻。

背景血清阴性绒毛萎缩的原因可分为乳糜泻或非乳糜泻。关于如何治疗血清阴性腹腔疾病尚无共识。目的评估CD3 + T细胞受体γδ+（TCRγδ+）上皮内淋巴细胞和腹腔淋巴管造影检查两者的准确性，以诊断血清阴性绒毛萎缩患者的腹腔疾病。方法纳入67例血清阴性的绒毛萎缩患者。在指数内窥镜下进行十二指肠活检以通过流式细胞术评估TCRγδ+和CD3-。腹腔淋巴图定义为TCRγδ+的增加加上CD3-上皮内淋巴细胞的减少。计算灵敏度，特异性和费根诺模图。结果诊断出腹腔疾病37例，非腹腔绒毛萎缩30例。乳糜泻患者年龄较小（39±3 vs 55±3岁； P = 0.001），更常出现HLA-DQ2 / 8（97.6％vs 61％； P = 0.002），与非乳糜泻相比，组织学更为严重（61％比32％Marsh 3b-c； P = 0.055）。腹腔淋巴管造影的敏感性为87％（CI，73.7-95），特异性为96.7％（82.7-99.9），而仅评估TCRγδ+的敏感性为91.3％（79.2-97.6），特异性为83.3％（ 65.3-94.3）。在测试前腹腔疾病概率为30％的患者中，阳性和阴性腹腔淋巴瘤的测试后概率分别为92％和5％，阳性和阴性TCRγδ+分别为70％和4％。