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EATL & Celiac Disease

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Association with Celiac Disease: Enteropathy-associated T-cell lymphoma (EATL) is a known complication of celiac disease. Both conditions share many features, including the presence of anti-endomysial antibodies, HLA-DQ2 or HLA-DQ8 alleles, and the beneficial effects of gluten-free diet. Clinical conditions such as dermatitis herpetiformis are seen in both. Refractory celiac disease may be diagnosed prior to EATL (more frequently) or concomitant with EATL (less frequently). In some patients with EATL, celiac disease is clinically silent and only diagnosed at autopsy.

Refractory Celiac Disease (RCD): Defined as persistence of gastrointestinal symptoms as well as abnormal architecture of small intestinal mucosa despite being on a strict gluten-free diet for 6-12 months. Other celiac disease-related conditions must be excluded, including microscopic colitis, bacterial overgrowth, intestinal lymphoma, autoimmune enteropathy, and common variable immunodeficiency.

This image shows changes of Celiac disease in the mucosa adjacent to EATL. There is villous atrophy and blunting, crypt hyperplasia, intraepithelial lymphocytes, and chronic inflammation. Discussion of celiac disease and its relationship to EATL continues in the next slide.

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