Background and Aims The immunohistochemical application of CD3 (T lymphocytes) and CD20 (B lymphocytes) markers in duodenal biopsy can facilitate the detection of the number and distribution of intraepithelial lymphocytes along the villi, which is regarded as a key factor for accurate diagnosis of celiac disease. This study aims at finding a relationship between CD3 and CD20 immunohistochemical and histopathological alterations of celiac disease, and at investigating whether the application of those immunohistochemical stainings would improve the detection of lymphocytosis within the epithelium and add advantages to celiac disease diagnosis. Methods Biopsies were obtained from 100 individuals and stained with hematoxylin and eosin (H&E). They were then evaluated according to the Marsh classification. After that, staining for CD3 and CD20 was individually done and assessed. Results The overall mean intraepithelial lymphocyte count per 100 enterocytes for H&E was 23.1 (95% confidence interval [CI] = 19.52–26.68), and for immunohistochemistry by CD3 and CD20 was 27.84 (95% CI = 24.31–31.38). The difference was highly significant, P = 0.001. The expression of CD3 immunohistochemically was as follows: Less‐than‐half staining pattern was reported in 16% cases, and half staining pattern was seen in 26%, while most cases 58% had more than half staining pattern. This discovery was consistent with the histological classification of March III among most cases. The expression of CD20 immunohistochemically was as follows: mild crypt involvement was observed in 16% of cases, while moderate crypt involvement and intense crypt involvement were seen in 43% and 41% of cases, respectively.

Background. Diagnosis of celiac disease depends on the patient’s history and serological tests, and is confirmed by biopsies from the duodenum. Biopsies from the small intestine could be dispensable regarding the verification of celiac disease with the presence of high levels of atissue-transglutaminase antibody.Aim. The objective of this investigation is to substantiate the correlation between titers of anti-tissue transglutaminase type IgA (anti-tTG IgA) and the severity of histological alterations in Syrian patients with celiac disease and to determine the diagnostic level of anti-tTG to previse celiac disease in adults and children without the necessity of a biopsy sampling.Materials and methods. The study was conducted as a prospective cohort study with the participation of 100 symptomatic patients between the age group of 6–65 years. All participants underwent upper gastrointestinal endoscopy. Two samples were taken from the duodenum and were evaluated by an expert pathologist according to Marsh grading. Serum anti-tTG IgA levels were measured as well to determine any association between the levels of serum anti-tTG IgA and Marsh grading.Results. The mean age of the patients was (18.55 ± 12.92). Anemia was the most frequent non-gastrointestinal finding as it was found among 35% of the participant, but no remarkable association was found between Marsh grading and hemoglobin levels (r = 0.36, p > 0.05). However, serum tTGA levels were positively correlated with Marsh grading (r = 0.718, p < 0.001). Receiver-operator curve (ROC) analysis cut-off value of serum anti-tTGA for speculating villous atrophy was 270 IU/ml of cut-off value with a sensitivity of 100% and a specificity of 89%.Conclusion. Duodenal biopsies could be foregone during the diagnosis of susceptible patients for celiac diseasewith high anti-tTG IgA.