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The terminal ileum is affected in patients with lymphocytic or collagenous colitis.

Publication ,  Journal Article
Sapp, H; Ithamukkala, S; Brien, TP; Ayata, G; Shaz, B; Dorfman, DM; Wang, HH; Antonioli, DA; Farraye, FA; Odze, RD
Published in: Am J Surg Pathol
November 2002

Lymphocytic colitis (LC) and collagenous colitis (CC) are diseases characterized by the presence of marked intraepithelial lymphocytosis. Both of these disorders affect primarily the colon. However, involvement of the distal small intestine has not been systematically studied. The purpose of this study was to evaluate the type and degree of intraepithelial lymphocytosis in the terminal ileum of patients with LC or CC. Terminal ileal mucosal biopsies from 22 patients with LC (male/female ratio 0.22, mean age 47 years) and 23 with CC (male/female ratio 0.43, mean age 54 years) were evaluated for the number of intraepithelial lymphocytes (IEL) per 100 epithelial cells (EC) both in the villi and crypts. The results were compared with 30 patients with inflammatory bowel disease (16 with Crohn's disease [CD], 14 with ulcerative colitis [UC]) and 24 patients (male/female ratio 0.33, mean age 44 years) without colonic pathology as normal controls. None of the patients had celiac sprue. Paired terminal ileum and colonic mucosal biopsies from 6 patients with LC, 4 with CC, 5 with CD, 5 with UC, and 10 normal controls were also immunohistochemically stained with monoclonal antibodies to CD3, CD8, CD20, and a class II MHC antigen (LN3-HLA-DR). In the villi the IEL count/100 EC was 11.8 +/- 1.8 in LC and 10.3 +/- 1.9 in CC (p = 0.3). These values were both significantly higher than in CD (2.8 +/- 0.4, p <0.001), UC (3.1 +/- 0.4, p <0.001), or normal controls (2.2 +/- 0.2, p <0.001). In the crypts the IEL count was 3.8 +/- 0.5 in LC and 3.2 +/- 0.5 in CC (p = 0.3). These values were also significantly higher than in CD (2.3 +/- 0.4, p = 0.02), UC (2.1 +/- 0.3, p = 0.02), or normal controls (1.5 +/- 0.2, p <0.001). The presence of >5 IELs/100 EC in terminal ileum biopsies was highly specific for LC and CC (specificity 98%, sensitivity 73% and 56% for LC and CC, respectively). The IEL phenotype was similar in all groups of patients and in the ileum and colon of individual patients. Intraepithelial lymphocytes were CD3+, CD8+, CD20-, and LN3-HLA-DR-, indicative of a suppressor T-cell phenotype. Intraepithelial lymphocytosis occurs in the terminal ileum in patients with LC or CC and may be helpful in diagnosing these conditions and distinguishing LC or CC from CD or UC in diagnostically difficult cases. The results suggest that the terminal ileum may be involved by a similar pathogenic process as the colon in LC and CC.

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Published In

Am J Surg Pathol

DOI

ISSN

0147-5185

Publication Date

November 2002

Volume

26

Issue

11

Start / End Page

1484 / 1492

Location

United States

Related Subject Headings

  • Pathology
  • Middle Aged
  • Male
  • Lymphocytosis
  • Intestinal Mucosa
  • Immunoenzyme Techniques
  • Ileum
  • Humans
  • Female
  • Collagen
 

Citation

APA
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ICMJE
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Sapp, H., Ithamukkala, S., Brien, T. P., Ayata, G., Shaz, B., Dorfman, D. M., … Odze, R. D. (2002). The terminal ileum is affected in patients with lymphocytic or collagenous colitis. Am J Surg Pathol, 26(11), 1484–1492. https://doi.org/10.1097/00000478-200211000-00011
Sapp, Heidi, Sarathehandra Ithamukkala, Tom P. Brien, Gamze Ayata, Beth Shaz, David M. Dorfman, Helen H. Wang, Donald A. Antonioli, Francis A. Farraye, and Robert D. Odze. “The terminal ileum is affected in patients with lymphocytic or collagenous colitis.Am J Surg Pathol 26, no. 11 (November 2002): 1484–92. https://doi.org/10.1097/00000478-200211000-00011.
Sapp H, Ithamukkala S, Brien TP, Ayata G, Shaz B, Dorfman DM, et al. The terminal ileum is affected in patients with lymphocytic or collagenous colitis. Am J Surg Pathol. 2002 Nov;26(11):1484–92.
Sapp, Heidi, et al. “The terminal ileum is affected in patients with lymphocytic or collagenous colitis.Am J Surg Pathol, vol. 26, no. 11, Nov. 2002, pp. 1484–92. Pubmed, doi:10.1097/00000478-200211000-00011.
Sapp H, Ithamukkala S, Brien TP, Ayata G, Shaz B, Dorfman DM, Wang HH, Antonioli DA, Farraye FA, Odze RD. The terminal ileum is affected in patients with lymphocytic or collagenous colitis. Am J Surg Pathol. 2002 Nov;26(11):1484–1492.

Published In

Am J Surg Pathol

DOI

ISSN

0147-5185

Publication Date

November 2002

Volume

26

Issue

11

Start / End Page

1484 / 1492

Location

United States

Related Subject Headings

  • Pathology
  • Middle Aged
  • Male
  • Lymphocytosis
  • Intestinal Mucosa
  • Immunoenzyme Techniques
  • Ileum
  • Humans
  • Female
  • Collagen