{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T01:43:09Z","timestamp":1791164589187,"version":"4.1.0"},"reference-count":36,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[2003,2]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Refractory coeliac sprue (RCS) with an immunophenotypically aberrant clonal intraepithelial lymphocyte (IEL) population is considered a cryptic form of intestinal T cell lymphoma.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Aims:<\/jats:bold>\n                    To investigate the distribution of the abnormal and monoclonal IEL population in the digestive tract of RCS patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Patients and methods:<\/jats:bold>\n                    We compared the frequency of lymphocytic gastritis (LG) and lymphocytic colitis (LC), together with IEL phenotype and T cell clonality, in gastric and colonic samples from 15 adults with RCS (all with aberrant CD3 intracytoplasmic\n                    <jats:sup>+<\/jats:sup>\n                    surface\n                    <jats:sup>\u2212<\/jats:sup>\n                    CD8\n                    <jats:sup>\u2212<\/jats:sup>\n                    clonal IELs on duodenojejunal biopsies), 18 patients with active coeliac disease (ACD), and 10 patients with coeliac disease (CD) on a gluten free diet (GFD-CD) by means of immunohistochemistry and multiplex polymerase chain reaction amplification of the T cell receptor \u03b3 gene (TCR-\u03b3) rearrangement. Blood samples of nine RCS patients were also tested for clonality.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    LG was found in 9\/14 (64%), 11\/18 (61%), and 3\/10 (30%) patients with RCS, ACD, and GFD-CD, respectively, while LC was found in 6\/11 (55%), 3\/4 (75%), and 2\/3 (66%) patients. Contrary to CD, all samples from patients with LG and LC showed an aberrant IEL phenotype. Monoclonal TCR-\u03b3 rearrangements were detected in 8\/13 (62%), 8\/10 (80%), and 4\/9 (44%) of gastric, colonic, and blood samples, respectively, from RCS patients, while in CD patients such rearrangements were only found in 2\/25 (8%) gastric samples.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    The immunophenotypically aberrant monoclonal IEL population present in the small intestine of patients with RCS frequently disseminates to the blood and the entire gastrointestinal epithelium, suggesting that this is a diffuse gastrointestinal disease.\n                  <\/jats:p>","DOI":"10.1136\/gut.52.2.205","type":"journal-article","created":{"date-parts":[[2003,1,10]],"date-time":"2003-01-10T14:05:40Z","timestamp":1042207540000},"page":"205-211","source":"Crossref","is-referenced-by-count":117,"title":["Refractory coeliac sprue is a diffuse gastrointestinal 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