ArticleGut2017
ROC-king onwards: intraepithelial lymphocyte counts, distribution & role in coeliac disease mucosal interpretation.
Article in Gut, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 68 citations in OpenAlex.
- AGA Clinical Practice Update on Diagnosis and Monitoring of Celiac Disease-Changing Utility of Serology and Histologic Measures: Expert Review.Gastroenterology · 2019Guideline
- Latiglutenase Protects the Mucosa and Attenuates Symptom Severity in Patients With Celiac Disease Exposed to a Gluten Challenge.Gastroenterology · 2022Trial
- Diagnostic Challenges in Enteropathies: A Histopathological Review.Diagnostics (Basel, Switzerland) · 2025Review
- Will Rogers Paradox in Gastroenterology.Digestive diseases and sciences · 2025Review
- Assessment of Intraepithelial Lymphocytes Count in Potential Celiac Disease.APMIS : acta pathologica, microbiologica, et immunologica Scandinavica · 2025Article
- A Composite Morphometric Duodenal Biopsy Mucosal Scale for Celiac Disease Encompassing Both Morphology and Inflammation.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2024Article
- Guidelines for best practices in monitoring established coeliac disease in adult patients.Nature reviews. Gastroenterology & hepatology · 2024Review
- Computer-Based Diagnosis of Celiac Disease by Quantitative Processing of Duodenal Endoscopy Images.Diagnostics (Basel, Switzerland) · 2023Article
- Marsh's legacy and persistency in subjective interpretation of coeliac disease's histology.Gastroenterology and hepatology from bed to bench · 2023Article
- Article
- Population-based screening for celiac disease reveals that the majority of patients are undiagnosed and improve on a gluten-free diet.Scientific reports · 2022Article
- Nomenclature and Definition of Atrophic Lesions in Small Bowel Capsule Endoscopy: A Delphi Consensus Statement of the International CApsule endoscopy REsearch (I-CARE) Group.Diagnostics (Basel, Switzerland) · 2022Article
- The Effect of Gluten-Free Diet Duration on Body Mass Index of Iranian Patients with Celiac Disease.Middle East journal of digestive diseases · 2022Article
- Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study.Nutrients · 2022Article
- Article
- Minimal Lesions of the Small Intestinal Mucosa: More than Morphology.Digestive diseases and sciences · 2020Review
- Histopathology of Celiac Disease. Position Statements of the Italian Group of Gastrointestinal Pathologists (GIPAD-SIAPEC).Translational medicine @ UniSa · 2020Article
- Utility of narrow band imaging in predicting histology in celiac disease.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2020Article
- Anxiety Symptoms in Adult Celiac Patients and the Effect of a Gluten-Free Diet: An Iranian Nationwide Study.Inflammatory intestinal diseases · 2020Article
- Diagnosing coeliac disease: Out with the old and in with the new?World journal of gastroenterology · 2020Review
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Authors and funding
41 authors at 20 institutions in 8 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesCounting intraepithelial lymphocytes (IEL) is central to the histological diagnosis of coeliac disease (CD), but no definitive 'normal' IEL range has ever been published. In this multicentre study, receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off between normal and CD (Marsh III lesion) duodenal mucosa, based on IEL counts on >400 mucosal biopsy specimens.
designThe study was designed at the International Meeting on Digestive Pathology, Bucharest 2015. Investigators from 19 centres, eight countries of three continents, recruited 198 patients with Marsh III histology and 203 controls and used one agreed protocol to count IEL/100 enterocytes in well-oriented duodenal biopsies. Demographic and serological data were also collected.
resultsThe mean ages of CD and control groups were 45.5 (neonate to 82) and 38.3 (2-88) years. Mean IEL count was 54±18/100 enterocytes in CD and 13±8 in normal controls (p=0.0001). ROC analysis indicated an optimal cut-off point of 25 IEL/100 enterocytes, with 99% sensitivity, 92% specificity and 99.5% area under the curve. Other cut-offs between 20 and 40 IEL were less discriminatory. Additionally, there was a sufficiently high number of biopsies to explore IEL counts across the subclassification of the Marsh III lesion.
conclusionOur ROC curve analyses demonstrate that for Marsh III lesions, a cut-off of 25 IEL/100 enterocytes optimises discrimination between normal control and CD biopsies. No differences in IEL counts were found between Marsh III a, b and c lesions. There was an indication of a continuously graded dose-response by IEL to environmental (gluten) antigenic influence.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.