Virchows Archiv

, Volume 474, Issue 5, pp 641–642 | Cite as

Morphologic spectrum of gluten-related disorders: how far to go?

  • Ayca Kirmizi
  • Arzu EnsariEmail author
Letter to the Editor

Dear Editor,

We read the letter written by Barbara Zanini, Anna Bozzola, and Vincenzo Villanacci regarding our paper titled “Discriminant value of IEL counts and distribution pattern through the spectrum of gluten sensitivity: a simple diagnostic approach” [1], with great interest. We are glad to see that our paper has incited a pleasant discussion among experts in which we would like to participate and clarify certain points raised by Zanini et al. in their letter.

Ours was a retrospective study, so we do not know whether the non-celiac IELosis group corresponds to NCGS, as the diagnosis depends on the exclusion of the other causes of IELosis together with response to GFD followed by a single or double-blind placebo-controlled gluten challenge [2]. It seems likely, however, that some of our cases may indeed be NCGS, based on their symptoms, negative serology, and normal or mildly increased IEL counts in the duodenal biopsy [1]. Nevertheless, we did not compare the histology of...



Ayca Kirmizi and Arzu Ensari wrote together the manuscript and gave final approval for publication.

Compliance with ethical standards

The authors declare that the study has been done according to ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kirmizi A, Kalkan C, Yuksel S, Gencturk Z, Savas B, Soykan İ, Cetinkaya H, Ensari A (2018) Discriminant value of IEL counts and distribution pattern through the spectrum of gluten sensitivity: a simple diagnostic approach. Virchows Arch 473:551–558. CrossRefPubMedGoogle Scholar
  2. 2.
    Catassi C, Elli L, Bonaz B, Bouma C, Carroccio A, Castilllejo G et al (2015) Diagnosis of non-celiac gluten sensitivity (NCGS): the Salerno experts’ criteria. Nutrients 7:4966–4977.
  3. 3.
    Zanini B, Villanacci V, Marullo M, Cadei M, Lanzarotto F, Bozzola A, Ricci C (2018) Duodenal histological features in suspected non celiac gluten sensitivity: new insights into a still undefined condition. Virchows Arch 473:229–234.
  4. 4.
    Talley NJ, Walker MM, Aro P, Ronkainen J, Storskrubb T, Hindley LA, Harmsen WS, Zinsmeister AR, Agréus L (2007) Non-ulcer dyspepsia and duodenal eosinophilia: an adult endoscopic population-based case-control study. Clin Gastroenterol Hepatol 5(10):1175–1183CrossRefPubMedGoogle Scholar
  5. 5.
    Marsh MN (1992) Gluten, major and the histocompatibility small intestine complex, a molecular and immunobiologic approach to spectrum of gluten sensitivity (“celiac sprue”) Gastroenterology 102:330–354Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pathology, Faculty of MedicineAnkara UniversityAnkaraTurkey

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