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The Decreasing Prevalence of Severe Villous Atrophy in Dermatitis Herpetiformis: A 45-Year Experience in 393 Patients.
- Source :
-
Journal of clinical gastroenterology [J Clin Gastroenterol] 2017 Mar; Vol. 51 (3), pp. 235-239. - Publication Year :
- 2017
-
Abstract
- Goals: We analyzed from our prospectively collected series of patients with dermatitis herpetiformis (DH) whether small-bowel histologic findings are changing and how serum tissue transglutaminase (TG2) IgA antibodies correlate to mucosal damage.<br />Background: DH is an extraintestinal manifestation of celiac disease presenting with itchy blistering rash and pathognomonic IgA deposits in the skin. Prominent gastrointestinal symptoms are rare, and small-bowel findings range from severe villous atrophy (SVA) and partial villous atrophy (PVA) to normal mucosa with inflammatory changes.<br />Methods: The cohort included 393 patients (214 male and 179 female) with DH having small-bowel biopsies performed at Tampere University Hospital since 1970. The small-bowel findings were calculated in the three 15-year periods, and in the last period they were correlated with serum IgA class TG2 antibody levels measured by enzyme-linked immunosorbent assay.<br />Results: The prevalence of SVA decreased significantly (P=0.032), from 42% in the first study period to 29% in the last study period. A concomitant increase was seen in PVA, from 33% to 41%, and normal villous architecture, from 25% to 30%. The patients with SVA (P<0.001) and PVA (P=0.046) had significantly higher TG2 antibody levels than those with normal villous architecture.<br />Conclusions: This long-term study in patients with DH disclosed a significant decrease in the occurrence of SVA. Serum IgA TG2 antibody levels correlated to damage in the small bowel. The trend toward milder small-bowel histology in DH suggests that a similar pattern could occur in the pool of undiagnosed celiac disease from which DH develops.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Atrophy
Autoantibodies blood
Cohort Studies
Dermatitis Herpetiformis blood
Dermatitis Herpetiformis pathology
Diet, Gluten-Free
Female
Finland epidemiology
GTP-Binding Proteins immunology
Humans
Incidence
Male
Middle Aged
Prevalence
Protein Glutamine gamma Glutamyltransferase 2
Severity of Illness Index
Transglutaminases immunology
Young Adult
Dermatitis Herpetiformis epidemiology
Intestinal Mucosa pathology
Intestine, Small pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1539-2031
- Volume :
- 51
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of clinical gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 27136959
- Full Text :
- https://doi.org/10.1097/MCG.0000000000000533