Diagnosis is made by accurate counting of intraepithelial lymphocytes during histological examination of the duodenum. The definition of the condition includes the requirement that the<unk>  histological appearances are otherwise unremarkable, specifically with normal villous architecture. In coeliac disease (also known as gluten-sensitive enteropathy),<unk>  is found in untreated or partially treated cases. This is the least severe type of change, known as the Marsh I stage, in the classification of histological changes in coeliac disease. Additional features including villous atrophy and crypt hyperplasia are the other findings in other Marsh stages of coeliac disease. Antibodies associated with coeliac disease were reported in around 11% of cases. These IgA endomysial antibodies and anti-transglutaminase antibodies are very sensitive and specific for coeliac disease implying that this proportion of<unk>  cases has definite coeliac disease. Around 33% of cases have the HLA-DQ2 allele, which is found in over 90% of people with coeliac disease. Absence of HLA-DQ2 (and the rarer HLA-DQ8) makes coeliac disease most unlikely. As antibody-negative coeliac disease is recognised, HLA status, persistence or progression of the<unk>  IEL numbers following a gluten challenge, followed by symptomatic improvement on a gluten-free diet, has been used to be more certain about the diagnosis, which was made in 22% of one series of over 200 adult cases. Helicobacter infection is a common finding at endoscopy and although<unk>  IEL counts were found to be slightly higher with this infection, this was not considered to be a meaningful cause in children. Other infections, including Cryptosporidiosis and Giardiasis can also be associated with an increase in IELs.
Duodenal lymphocytosis
Anti-gliadin antibodies
Generalized lymphadenopathy
Wandering spleen
Aberrant crypt foci
Black stomach
Pancreatic acinar metaplasia
Tonsil stones