SNFGE SNFGE
 
Thématique :
- Coloproctologie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Frank ZERBIB
Coup de coeur :
 
 
Gut
  2018/09  
 
  2018 Sep;67(9):1606-1613.  
  doi: 10.1136/gutjnl-2017-314461.  
 
  HLA-DQ:gluten tetramer test in blood gives better detection of coeliac patients than biopsy after 14-day gluten challenge.  
 
  Sarna VK, Skodje GI, Reims HM, Risnes LF, Dahal-Koirala S, Sollid LM, Lundin KEA  
  https://www.ncbi.nlm.nih.gov/pubmed/28779027  
 
 

Abstract
 

OBJECTIVE:

Initiation of a gluten-free diet without proper diagnostic work-up of coeliac disease is a frequent and demanding problem. Recent diagnostic guidelines suggest a gluten challenge of at least 14 days followed by duodenal biopsy in such patients. The rate of false-negative outcome of this approach remains unclear. We studied responses to 14-day gluten challenge in subjects with treated coeliac disease.

DESIGN:

We challenged 20 subjects with biopsy-verified coeliac disease, all in confirmed mucosal remission, for 14 days with 5.7 grams per oral gluten daily. Duodenal biopsies were collected. Blood was analysed by multiplex assay for cytokine detection, and by flow cytometry using HLA-DQ:gluten tetramers.

RESULTS:

Nineteen participants completed the challenge. Villous blunting appeared at end of challenge in 5 of 19 subjects. Villous height to crypt depth ratio reduced with at least 0.4 concomitantly with an increase in intraepithelial lymphocyte count of at least 50% in 9 of 19 subjects. Interleukin-8 plasma concentration increased by more than 100% after 4 hours in 7 of 19 subjects. Frequency of blood CD4+effector-memory gut-homing HLA-DQ:gluten tetramer-binding T cells increased by more than 100% on day 6 in 12 of 15 evaluated participants.

CONCLUSION:

A 14-day gluten challenge was not enough to establish significant mucosal architectural changes in majority of patients with coeliac disease (sensitivity ≈25%-50%). Increase in CD4+ effector-memory gut-homing HLA-DQ:gluten tetramer-binding T cells in blood 6 days after gluten challenge is a more sensitive and less invasive biomarker that should be validated in a larger study.

TRIAL REGISTRATION NUMBER:

NCT02464150.

 
Question posée
 
Comment faire le diagnostic de maladie coeliaque chez un patient sous régime sans gluten ?
 
Question posée
 
Un test de réintroduction de 14 jours ne permet pas de faire un diagnostic correct sur les biopsies. Une augmentation dans le sang du nombre de lymphocytes T HLA-DQ fixant les tétramères de gluten à 6 jours est un test en revanche très sensible.
 
Commentaires

Le message le plus important de cette étude est qu’une réintroduction de 14 jours de gluten n’est pas suffisant si on se fie au résultat des biopsies. L’étude des lymphocytes T mémoire est prometteuse mais pas encore utilisable en routine. Il faut donc poursuivre plus longtemps la réintroduction du gluten (1 mois ?) avant de pratiquer des biopsies duodénales.

 
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