Aim :Recently,we reported typical endoscopic findings and an increment in γδ+ Tcells in the foregut among children with food-sensitive enteropathy other than coeliac disease.To find outthe extend to which the upregulation of the local immune response might explain gastrointestinal (GI)complaints of the foregut,we sought to exam ine by the increm ent in γδ+ T cells a 1-y consecutive series of children referred for recurrent G I com plaints to a ter- tiary-levelhospital.M ethods:A 1-y cohort of 102chil- dren scheduled for gastroduodenoscopy were exam ined for m ucosalhistology and the densities ofCD3+,αβ+ and γδ+ T-cell subsets from m id-duodenal specim ens.The final diagnostic categories were used in analysing the data. Results:Fifteen subjects showed villous atrophy and a high γδ+ T-cell density;the finding being com patible with coeliac disease (CD ).Atthe otherextrem e,20subjects in whom diagnostic G I diseases were ruled out showed low densities and served as controls.The subjects reporting GI symptom s after an open food challenge with m ilk and /or cereals (n = 18)as well as children rem ittingwith am ilk-or cereal-elim inating diet but not responding to a challenge (n = 23)also expressed significantly higher densities ofγδ+ T cells than the controls.In all,45of102 children could be considered to have an elevated γδ+ T-cell density as an indication of locally activated im m une re- sponse. Lack of villous architecture and lym phonodular hyperplasia of the duodenal bulb as an endoscopie finding and atopic derm atitis but not the presence of D Q2alleles showed a close association with these increased densities. Conclusion:Considering thatan elevated incidence ofj6+ T cells is an indication of m ucosal response against lum inal antigens,up to halfthe children with prolonged G I sym p- tom s have im m une m ediated disorder;CD and food allergy being the m ostobvious clinicalentities.
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