Biopsy results.Question about inflammatory cells
 

So we got the results back today and everything seems normal. The doctor told me that if celiac runs in the family she could have a gluten intolerance. She told me to take her off of gluten for 3 months. After this, she has another appt. and if there is not an improvement or at least a little weight gain that they will start testing for other things. The one thing that confuses me about her biopsy report is this.....The lamina propria of the antrum contains focally crowded mononuclear inflammatory cells. It then goes on to say that acute inflammation is not identified on routine stained sections. Anyone???

No clue, you might try to google a few keywords and see what you can find.

But what is really remarkable is that your doctor recommended the GF diet anyway! Wow, good doctor.

I can't really help except to share my daughters results which read:


Antral description:
Microscopic examination demonstrates fragments of fundic-type and antral-type gastric mucosa. A focal lymphoplasmacytic cell infiltrate is seen in the lamina propria, compatible with minimal chronic gastritis. A special stain has been ordered to rule out Helicobacter pylori-like organisms and a final diagnosis will follow. There is no evidence of malignancy.
(the h. pylori stain was negative)

A Braintalk friend wondered why a 15 year old would have chronic gastritis, and forwarded this link to me on chronic gastritis where I read about lymphocytic gastritis being a non-specific finding often associated with h. pylori or gluten sensitive enteropathy.
http://www.emedicine.com/med/topic852.htm

Check out the the page in The Gluten File about h. pylori, lymphocytic gastritis and colitis, for whatever its worth. H. pylori, Lymphocytic Gastritis & Colitis (particularly the lymphocytic gastritis)

Now, I don't know my "mononuclear inflammatory cells" from a "focal lymphoplasmacytic cell infiltrate", or any of the other terms really, so I may be grasping at straws (I sometimes take great leaps)...but I am happy to hear your doctor favors a dietary trial... and I hope you will see positive changes!

Cara

So this is what I found.....
The basic histological structure of the alimentary tract is similar throughout its length and comprises several layers. Beneath the surface epithelium (which varies in type from region to region) and its basement membrane, is a lamina propria, a loose fibrovascular connective tissue which in many filled with mononuclear inflammatory cells ready to deal with invading antigens, including plasma cells that make IgA that is transported into the gut lumen.

Since your doctor is suggesting trying the gf diet (Hooray!! Good doc.!), I would ask more questions about the above-noted quote.

Acute inflammation does not mean 'no inflammation'. It may mean some inflammation. I would ask if the inflammation was identifiable as Marsh I, II or III lesions. This would bring you a little further along in defining what you're dealing with.

That being said, there was a study in which it was noted that the majority of celiacs (whether they had symptoms or not) did suffer inflammation of the intestinal lining. I do not remember the inflammation being bad enough to be deemed a Marsh lesion and don't have time to look it up... But in the end, who wants ANY inflammation in their intestines anyway? Therefore, even if they are not considered Marsh, you'll still want to try eliminating various foods starting with the obvious (gluten and dairy). However, if it was deemed Marsh I or II, then that would clearly explain why the doc said that she could be gluten sensitive and needs to be gf. Marsh III is boardroom celiac and if you go for a biopsy and don't show Marsh III, then they don't usually call you celiac and won't suggest the diet... even though many, many people will subsequently show with Marsh III at a later date if they show I or II in a preliminary biopsy.

That's my understanding of the studies anyway. Clear as mud right? :D

Read it 10 times and it gets clearer. :)