The purpose of this study was to evaluate the use of rectal gluten challenge in the diagnosis of coeliac disease. A total of 103 patients with features suggestive of this diagnosis were prospectively enrolled into the study; a diagnosis of coeliac disease was based on strictly defined criteria used in judging the proximal jejunal biopsy. On that basis, 45 out of the 103 patients were deemed to have coeliac disease. A slurry of gluten powder in physiological saline was introduced into the rectum, and biopsies taken before and at 2 h or 4 h after the challenge were examined immunohistochemically by computerized image analysis. Cell counts were analysed by logistic regression, and the best equations were obtained for each challenge group. The 2 h challenge yielded diagnostic sensitivity and specificity of 69.6% and 78.6% respectively. The 4 h challenge provided sensitivity and specificity of 100% and 100% respectively. These results were compared with other clinical diagnostic predictors, including anti-endomysial antibodies, which yielded diagnostic sensitivity and specificity of 70% and 98% respectively. It is concluded that a 4 h rectal challenge is a highly sensitive means of identifying gluten-sensitized individuals, and would be of particular value in cases showing negative antibody screening or equivocal biopsy appearances.
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Research Article|
July 25 2001
Diagnosing coeliac disease by rectal gluten challenge: aprospective study based on immunopathology, computerized image analysisand logistic regression analysis
Arzu ENSARI;
Arzu ENSARI
*University Department of Medicine, Hope Hospital, Salford, Greater Manchester M6 8HD, U.K.
†Department of Pathology, University of Ankara, Sihhiye 06430 Ankara, Turkey
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Michael N. MARSH;
*University Department of Medicine, Hope Hospital, Salford, Greater Manchester M6 8HD, U.K.
Correspondence: Dr M. N. Marsh (e-mail [email protected]).
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Shethah MORGAN;
Shethah MORGAN
*University Department of Medicine, Hope Hospital, Salford, Greater Manchester M6 8HD, U.K.
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Robert LOBLEY;
Robert LOBLEY
‡Department of Chemical Pathology, Manchester Royal Infirmary NHS Trust, Manchester M13 9WL, U.K.
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D. J. UNSWORTH;
D. J. UNSWORTH
§Department of Clinical Immunology, Southmead Hospital, Bristol BS10 5NB, U.K., ƂMedical Research Council Environmental Epidemiology Unit, Southampton General Hospital, Southampton SO1 6YD, U.K.
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Daphne KOUNALI;
Daphne KOUNALI
§Department of Clinical Immunology, Southmead Hospital, Bristol BS10 5NB, U.K., ƂMedical Research Council Environmental Epidemiology Unit, Southampton General Hospital, Southampton SO1 6YD, U.K.
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Peter T. CROWE;
Peter T. CROWE
*University Department of Medicine, Hope Hospital, Salford, Greater Manchester M6 8HD, U.K.
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Jane PAISLEY;
Jane PAISLEY
ǁDepartment of Gastroenterology, Royal Bolton Hospital, Bolton BL4 0JR, Lancashire, U.K.
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Kieran J. MORIARTY;
Kieran J. MORIARTY
ǁDepartment of Gastroenterology, Royal Bolton Hospital, Bolton BL4 0JR, Lancashire, U.K.
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John LOWRY
John LOWRY
**Department of Oral Surgery, Royal Bolton Hospital, Bolton BL4 0JR, Lancashire, U.K.
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Publisher: Portland Press Ltd
Received:
December 14 2000
Revision Received:
March 20 2001
Revision Received:
May 15 2001
Online ISSN: 1470-8736
Print ISSN: 0143-5221
The Biochemical Society and the Medical Research Society © 2001
2001
Clin Sci (Lond) (2001) 101 (2): 199–207.
Article history
Received:
December 14 2000
Revision Received:
March 20 2001
Revision Received:
May 15 2001
Citation
Arzu ENSARI, Michael N. MARSH, Shethah MORGAN, Robert LOBLEY, D. J. UNSWORTH, Daphne KOUNALI, Peter T. CROWE, Jane PAISLEY, Kieran J. MORIARTY, John LOWRY; Diagnosing coeliac disease by rectal gluten challenge: aprospective study based on immunopathology, computerized image analysisand logistic regression analysis. Clin Sci (Lond) 1 August 2001; 101 (2): 199–207. doi: https://doi.org/10.1042/cs1010199
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