Kilessa A. Integrated morphologіcal diagnostics of gluten enteropathy

Dissertation is devoted to study of structural features of duodenal mucosa at gluten enteropathy and development of differential diagnostic criteria for the disease. Video endoscopy with high-magnifying, high-resolution and narrow band imaging regime was carried out for 1814 patients, from them frequency gluten enteropathy is 6.2%. It was established that typical changes in structure of duodenal mucosa villi occured at gluten enteropathy. They are: an obliteration of the lacteal (as confirmed by histological examination), oblique-horizontal and horizontal positions of villi. Whereas, at chronic nonspecific duodenitis villi location is chaotic and lacteals are not obliterated. Phenotyping of lymphocytes in duodenal mucosa revealed pathognomonic sign for all stages of gluten enteropathy – statistically significant increasing of CD8+ lymphocytes maintenance in comparison with chronic nonspecific duodenitis. Besides, it was emerged that an increase of proliferative activity index of crypts epithelium, defined by monoclonal antibodies Ki-67, was typical for hyperplastic and atrophic stages of the disease. Changes in duodenal enterocyte ultrastructures at a progression of gluten enteropathy were characterized by step-by-step reduction of villi quantity and height, focal loss of absorbtive cells villi, increased quantity of «young» and «matured» Paneth cells in crypts. At terminal (atrophic) stage of gluten enteropathy a number of Paneth cells decreased and of enteroendocrine cells – increased. Simultaneously, enterocytes destruction and plasmatization of duodenal mucosa infiltrate occurred. Algorithm of integrated morphologіcal diagnostics of gluten enteropathy and it morphologіcal differential diagnostic criteria were worked out.