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A paradox lies in the fact that intraepithelial lymphacyte infiltration is normally a part of the histology of celiac sprue, but it is not considered to be an official part of normal celiac histopathological changes.
Here are the official current diagnostic criteria for pathological diagnosis of celiac disease, (IOW, this is what pathologists have to follow, when diagnosing celiac sprue):
http://www.pathologyoutlines.com/smallb ... eliacsprueDiagnosis: antitransglutaminase or antigliadin or antiendomysial antibodies plus clinical malabsorption plus typical histologic findings plus improvement in symptoms and histology after gluten withdrawal
The presence of an increase in intraepithelial lymphocytes, is not a requirement, when determining a diagnosis, though it is often noted in pathology reports, based on biopsy sample analysis. IOW, they know that the lymphocytes are there, but they are not allowed to consider that information when rendering a "verdict".
This is from an ooooold article, (1972), but obviously mainstream medicine has totally ignored the findings:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785442/Increased lymphocytic infiltration of the epithelium of the small intestine seems a surer sign of gluten sensitivity than the macroscopic appearance of the mucosa, and a diagnosis of gluten-sensitive enteropathy may no longer be excluded when the mucosa appears normal.
IOW, "they", (pathologists) choose to ignore the better measure of gluten sensitivity, (increased lymphocyte presence), in order to use an inferior, (but somewhat easier to see and understand) marker, namely villus atrophy. Why?
Beats me - probably they're just reluctant to change their old, obsolete methods. 
I find myself wondering who comprises the decision-making group, (or groups), that determines and sets the standards by which pathologists diagnose diseases. Are they doctors? Or could they be representatives of the same insurance companies and drug manufacturers that determine everything about the medical care that we receive these days?
Just kidding, of course.The bottom line is, the markers are there, (increases in intraepithelial lymphocytes), but they choose to ignore them, and focus on a different type of inflammation, instead - namely, villus attrophy. They ambiguously refer to the necessary findings as, "typical histologic findings", but the intraepithelial lymphocytic infiltration is ignored, in the absence of villus atrophy, which makes it irrelevant, in their eyes.
In your report, (that you mentioned above), the finding of no "inflammatory changes of sprue", would not rule out increased lymphocytic infiltration, because that is not officially considered to be a necessary condition for the diagnosis of CS. To them, the presence of increased lymphocytes is irrelevant, because they don't officially "know" what it means. Did you see the actual pathologist's report, or just the GI doc's interpretation of it? The original pathologist's endoscopy report probably mentions an elevated lymphocyte count.
I assume that my discussion above, covers that question. The bottom line is, they differentiate it by ignoring it, in the case of celiac sprue. Officially, LC of the small bowel, does not exist. (It cannot exist, because the name "colitis" applies only to the colon - colitis means inflammation of the colon. Period.). Scientists often get hung up on things such as taxonomy, nomenclature, and other syntax errors. It's kind of funny when most scientists do it, but when doctors play that game, people suffer, and sometimes they die, just because of a lack of flexibility in medical "rules".Faith wrote:If the intraepithelial lymphocytes occur in celiac disease too,how do they differentiate it from LC in small bowel, aside from atropy of the villi?
Incidentally, note that most doctors ignore the "plus improvement in symptoms and histology after gluten withdrawal" part of the rules. They might as well remove that stipulation, because they don't bother to change a diagnosis, just because a patient does not respond to treatment. With celiac disease, the diagnosis is final, regardless of the outcome, and, of course, it should be final. IOW, that "requirement" in the diagnostic regimen, is totally redundant.
I hope I haven't just confused the issue.
Tex
...... we find ourselves, apparently, back in the thick of it......
Sorry to hear about your setback, especially since you were doing so well. It's a good idea to back to an earlier phase of MRT, when things were under control, so you can settle things down again. That way you can start to test every food again. Otherwise you might be guessing at what caused the problem. It's important to know for sure so you don't unnecessarily eliminate some foods. 
. This is where this "family" is of utmost importance, as the emotional support helps us cope and live through such crushing disappointments.