ROC-king onwards: intraepithelial lymphocyte counts, distribution and role in coeliac disease mucosal interpretation

We read with interest the paper of Rostami et al, which was recently published in Gut. Counting intraepithelial lymphocytes (IEL) is considered highly useful in the histological evaluation of small intestinal biopsy specimens. When combined with the assessment of mucosal architecture and of inflammatory cells in the lamina propria, a precise histological diagnosis is possible in the majority of cases. Currently, there is an ongoing debate on the number of IEL that can safely be considered diagnostic for coeliac disease (CD). In our opinion, the recently published attempt by Rostami et al1 turns out to be insignificant due to the following shortcomings: the controls used were neither sex-matched nor age-matched. Controls showing any abnormality which might result in an increase in IEL counts were excluded. It was not stated whether biopsies were obtained from the duodenal bulb (D1) or the descending part (D2) of the duodenum. Finally, the...

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