Histopathological diagnosis of gluten-sensitive enteropathy

An approach to duodenal biopsies

“…22 It is characterised by an increase in the length of crypts, a reduction in the normal C:V ratio and an increased number of mitoses due to extension of the proliferative compartment from the crypt bases along the length of the crypt.…”

“…28 The acute inflammation can be so intense that it mimics a peptic ulcer. 22 The increase in neutrophils is dependent on the gluten dose. 28 Eosinophils are sometimes prominent and infiltrate the epithelium 22 in GSE and in food allergy.…”

“…22 The increase in neutrophils is dependent on the gluten dose. 28 Eosinophils are sometimes prominent and infiltrate the epithelium 22 in GSE and in food allergy. 29 30 The lamina propria may be colonised by Cryptococcus or infiltrated by plump macrophages in mycobacterial infection, leishmaniasis or Whipple's disease.…”

“…IELs tend to be squeezed between epithelial cells; they are sometimes surrounded by a pale halo and they may also show various shapes. 22 This variation in the appearance can increase the risk of underestimating the IEL count. The thickness of the sections may influence the IEL count.…”

“…The thickness of the sections may influence the IEL count. 22 The use of immunohistochemical analysis in architecturally normal villi is suggested, especially when GSE is suspected. 22 The assessment of IELs has evolved since the 1970s.…”