Flow cytometry opens new avenues for the early diagnosis of celiac disease.

Celiac disease is an autoimmune disorder that affects the small intestine and, despite its high prevalence, remains underdiagnosed. The complexity of its diagnosis lies in the fact that not all patients present with classic digestive symptoms or obvious abnormalities in standard tests.

"Celiac disease is very heterogeneous. Many patients have mild, atypical digestive symptoms or even extraintestinal manifestations such as anemia, headaches, infertility, osteoporosis, or chronic fatigue.Others may be completely asymptomatic," explains Dr. Natalia López Palacios, a gastroenterologist at Ruber International Hospital.

Furthermore, in the early stages of the disease or in people who have reduced their gluten intake on their own, serological tests and conventional biopsies may be normal or inconsistent, making it difficult to reach a conclusive diagnosis

Immunological Analysis Beyond the Microscope

In this regard, advanced diagnostic techniques that allow for a more precise study of the intestinal mucosa's immune response have become particularly relevant. One such technique is the study of intraepithelial lymphocytes in duodenal biopsies using flow cytometry.

"This involves analyzing the lymphocytes present in the epithelium of the small intestine. Thanks to flow cytometry, we can identify an immunological pattern characteristic of celiac disease," explains Dr. López Palacios.

Unlike conventional histology, which focuses on detecting structural damage to the intestine—such as villous atrophy—this technique allows for the identification of immunological alterations that persist over time, even when the patient is following a gluten-free diet and the mucosa has returned to its normal appearance.

The Value of the "Celiac Pattern"

One of the key findings of this technique, performed at the Ruber International Hospital, one of the few centers currently offering it, is the identification of the so-called "celiac pattern," a specific alteration in the proportion of intraepithelial lymphocytes.

"This pattern is characterized by an increase in gamma-delta T lymphocytes and a decrease in CD3- cells. It is highly specific to celiac disease and allows us to confirm the diagnosis when other tests are inconclusive," says the specialist.

This information is especially useful in patients with seronegative celiac disease, with minimal histological lesions (Marsh 1 and 2), in cases with discordant results between serology and biopsy, or in people who have started a gluten-free diet without prior medical advice.

A recognized and readily available tool in private healthcare

The usefulness of this technique is recognized in the Ministry of Health's Protocol for the Early Diagnosis of Celiac Disease, which recommends its use in complex or doubtful clinical situations.

"The incorporation of this test at Ruber International Hospital represents a significant diagnostic advancement in the private healthcare sector and allows us to offer a more precise, personalized, and reliable evaluation," emphasizes Dr. López Palacios.

The specialist also underscores the importance of avoiding self-diagnosis: "Celiac disease is a chronic condition that requires an accurate diagnosis, a family history, and a strict, lifelong gluten-free diet. Therefore, it is essential not to eliminate gluten without a specialized medical evaluation."