Intraepithelial lymphocytosis is an elevated white blood cell count in your gastrointestinal tract. It can be a sign of celiac disease, Crohn’s disease, or other gastrointestinal conditions.
The lining of your gastrointestinal (GI) tract plays a critical role in preventing infections. The outermost layer of your GI tract is called the epithelium. It contains T-cells that activate your body’s inflammation response.
T-cells are a type of white blood cells called lymphocytes. Most of the lymphocytes in your GI tract are T-cells.
Intraepithelial lymphocytosis is when doctors can see an increased number of lymphocytes in a tissue sample of your GI tract. It can be a sign of GI conditions such as Crohn’s disease or celiac disease. It goes by other names, such as duodenal lymphocytosis, depending on where in your GI tract these lymphocytes are detected.
Read on to learn about which conditions can cause intraepithelial lymphocytosis and how to manage them.
Intraepithelial lymphocytosis is an elevated lymphocyte count in your GI tract. It goes by several more specific names depending on where this elevated count is detected in your GI tract.
| Name | Part of GI affected |
|---|---|
| gastric intraepithelial lymphocytosis | stomach |
| duodenal intraepithelial lymphocytosis | first part of small intestines |
| jejunal intraepithelial lymphocytosis | middle of small intestines |
| ileal intraepithelial lymphocytosis | end of small intestines |
| colonic intraepithelial lymphocytosis | large intestines |
Intraepithelial lymphocytosis can be a sign of an issue with your gut. It’s characterized by
It’s thought that excessive lymphocyte activity in the GI tract is responsible for the gut damage seen in people with celiac disease and some other GI disorders.
Some of the functions of intraepithelial lymphocytes include:
- producing molecules that reduce inflammation
- activating natural killer cells that destroy infected or damaged cells
- producing molecules that increase inflammation
Excessive activity of natural killer cells has been linked to
In the following microscopic images taken from tissue samples, intraepithelial lymphocytes show up as dark purple spots.
Intraepithelial lymphocytosis is your body’s response to injury to your GI tract. A wide number of conditions can stimulate the overproduction of intraepithelial lymphocytes. They include:
- celiac disease
- tropical sprue
- inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease
- small intestinal bacterial overgrowth
- allergy to dairy or soy
- autoimmune enteropathy
- graft-versus-host disease
- drug-induced colitis
- GI ulcers
In a 2019 study, researchers examined the prevalence of gastrointestinal conditions in a group of 694 people with intraepithelial lymphocytosis of the stomach. The researchers reported:
| Condition | Prevalence in people with gastric intraepithelial lymphocytosis |
|---|---|
| severe obesity, previously known as “morbid obesity” | 23.5% |
| H. pylori infection | 23.5% |
| celiac disease | 14.7% |
| lymphocytic gastritis | 14.7% |
| nonspecific gastritis | 11.4% |
| IBD | 8.8% |
| gastroesophageal reflux disease (GERD) | 1.9% |
Half of the people in the study had intraepithelial lymphocytosis in both their stomach and small intestine.
Intraepithelial lymphocytosis can be a sign of an underlying gut disorder, but it isn’t a disorder itself. Symptoms can vary based on the underlying gut issue. Here are some examples:
Crohn’s disease
- diarrhea
- abdominal cramps
- blood in your stool
- fever
- feeling as if your bowels aren’t empty after a bowel movement
- frequent need for bowel movements
- fatigue
- loss of appetite
- weight loss
Celiac disease
- weight loss
- vomiting
- abdominal bloating
- abdominal pain
- persistent diarrhea or constipation
- pale, fatty, foul-smelling stools
Doctors may take a small tissue sample of the lining of your GI tract to help confirm the presence of a GI condition such as celiac disease. This tissue sample is called a biopsy.
Doctors can look at your biopsy under a microscope to see if you have an abnormal number of lymphocytes.
Treatment for intraepithelial lymphocytosis aims to target the underlying condition. Here are some of the potential treatment options:
| Condition | Treatment options |
|---|---|
| celiac disease | gluten-free diet |
| topical sprue | antibiotics |
| Crohn’s disease | • medications such as biologics and anti-inflammatory drugs • dietary changes • surgery |
| ulcerative colitis | • medications such as biologics and anti-inflammatory drugs • dietary changes • surgery |
| bacterial overgrowth | antibiotics |
| autoimmune enteropathy | immunosuppressants |
The outlook for conditions that cause intraepithelial lymphocytosis varies widely, but it’s often positive with proper treatment.
The outlook for people with celiac disease who follow a gluten-free diet is usually
Crohn’s disease may decrease quality of life. Life expectancy is
Intraepithelial lymphocytosis is when there is a higher than normal number of lymphocytes in the lining of your gastrointestinal tract. It can be a sign of gastrointestinal conditions such as celiac and Crohn’s disease.
Intraepithelial lymphocytosis isn’t a GI disorder. It’s a sign of an underlying problem. Treatment for intraepithelial lymphocytosis involves treating the underlying cause.