Coeliac Sprue: A Centennial Overview 1888-1988

Marsh, Michael N.; Loft, Duncan E.

doi:10.1159/000171198

Cited by 9 publications

(3 citation statements)

References 45 publications

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“…90 With this proposal-parenthetically, it bears resemblance to the type 1/type 2 lesions under ''Grade A''; combine type 3a and 3b lesions as ''Grade B1''; convert type 3c into ''Grade B2''; and discard type 4 lesions. 90 Although there are no obvious problems with this proposal-it bears resemblance to the early type 1 or type 2 classification initially forwarded by Marsh 93 -there is a risk that it may prove unnecessarily confusing for pathologists and clinicians, thereby defeating its stated intent. Perhaps at this juncture it is not unreasonable to call for a consensus among gastrointestinal pathologists to establish a standardised reporting approach to coeliac disease.…”

Section: Future Considerationsmentioning

confidence: 99%

Coeliac disease: an update for pathologists

2006

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Coeliac disease is the manifestation of an immune hypersensitivity reaction towards gluten and related proteins, in genetically predisposed people. Although the precise pathogenesis of this condition remains to be fully elucidated, it is probably multifactorial in origin. The diagnosis of coeliac disease has traditionally depended on intestinal biopsies alone; nowadays, the diagnosis has been expanded to include an array of serological markers. This review is intended to offer pathologists an update of the relevant history and immunopathology pertaining to coeliac disease and also to offer recommendations on the ongoing responsibilities of the pathologist in the diagnosis and reporting of coeliac disease.

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Section: Future Considerationsmentioning

confidence: 99%

Coeliac disease: an update for pathologists

2006

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“…GS can produce a spectrum of morphological abnormalities, ranging from architecturally normal villi to complete flattening 12–16 . Marsh characterized these abnormalities, and termed those biopsies with architecturally normal villi and increased IELs as stage I, infiltrative lesions 13–24 . Terms that have been applied to GS with architecturally normal small‐bowel mucosa include subclinical or silent coeliac sprue, gluten‐sensitive disease with mild enteropathy, low‐grade enteropathy, latent coeliac sprue, minimally symptomatic enteropathy or coeliac sprue, high‐density IEL enteropathy, and potential coeliac disease 4,10 , 20,25–33 .…”

Section: Gluten Sensitivitymentioning

confidence: 99%

Proximal small‐bowel mucosal villous intraepithelial lymphocytes

Goldstein

2004

Histopathology

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Small-bowel biopsies are routinely obtained from adult patients as a screening tool to evaluate the possibility of gluten sensitivity (GS). Previous morphological criteria of GS including completely flattened villi are usually absent. In the context of screening for GS, an altered distribution density pattern of villous intraepithelial lymphocytes (IELs) is probably the most sensitive morphological feature to suggest the possibility of GS and prompt the initiation of further medical evaluation. Altered villous IEL density distribution is a more sensitive screening feature than villous IEL counts. With increased small-bowel GS screening biopsies, occasional adults without GS with complete villous flattening and numerous villous IELs are encountered. These patients are usually incorrectly diagnosed with GS. However, they do not respond to a gluten-free diet and slowly improve over months.

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“…The incidence of coeliac disease is increasing worldwide, due to increased recognition of the variability in its clinical presentation. Since the fifties, the diagnosis of coeliac disease has depended on duodenal biopsy findings that include different degrees of villous atrophy along with crypt hyperplasia and intraepithelial lymphocytosis, which are graded by the Marsh classification (Marsh I-IIIC) ( 3 , 4 ). The development of highly sensitive serological tests such as anti-tissue transglutaminase (tTG autoantibodies), anti-endomysial antibody (EMA) and anti-deamidated gliadin peptides (anti-DGP antibodies) have facilitated the diagnosis of coeliac disease, particularly in asymptomatic patients or in patients with vague clinical presentations ( 5 , 6 ).…”

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confidence: 99%

Is the Diagnosis of Celiac Disease Possible Without Intestinal Biopsy?

Shomaf¹,

Rashid²,

Faydi³

et al. 2017

Balkan Med J

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Background: Coeliac disease is defined as a state of immune-mediated hyper-responsiveness to dietary gluten from wheat, barley, or rye in genetically predisposed individuals that results in tissue damage. The diagnosis is made by microscopic examination of a small intestinal biopsy, although serological testing for antibodies against tissue transglutaminase and deamidated gliadin peptide can be of great advantage. It has been suggested that duodenal biopsy can be avoided in patients with high levels of the tissue transglutaminase antibody, since a relationship has been found to be present between tissue transglutaminase antibody titres and coeliac disease.Aims: To study the correlation between tissue transglutaminase titre and small intestinal biopsy findings in patients with coeliac disease.Study Design:Diagnostic accuracy study.Methods: Ninety-five cases of patients diagnosed with coeliac disease and with positive serum tissue transglutaminase titres were retrieved from the Jordan University Hospital archives between December 2014 and December 2015. All the cases were classified according to the Marsh classification.Results: Ninety-five cases with a positive titre for the antibody were included in this study, 73 (76.8%) of them were females and 22 cases (23.2%) were males. The age of the patients ranged between 4 and 75 years with a mean age ± standard deviation of 32.3±14.7. The sensitivity was the highest in Marsh IIIC and lowest in Marsh IIIA (95% versus 68% respectively). The specificity was moderate (76%) for all subtypes of Marsh III.Conclusion: This study showed a positive correlation between the tissue transglutaminase titre and the degree of duodenal damage (Marsh IIIC) in patients with coeliac disease. In the presence of high tissue transglutaminase levels, duodenal biopsy might not be always necessary for diagnosis, particularly in symptomatic patients.

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Coeliac Sprue: A Centennial Overview 1888-1988

Cited by 9 publications

References 45 publications

Coeliac disease: an update for pathologists

Coeliac disease: an update for pathologists

Proximal small‐bowel mucosal villous intraepithelial lymphocytes

Is the Diagnosis of Celiac Disease Possible Without Intestinal Biopsy?

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