Duodenal biopsy for suspected celiac disease

Histological examination of duodenal biopsy for celiac disease is a specialized test that is considered the «gold standard» for diagnosing gluten enteropathy. Unlike a general biopsy, it focuses on microscopic changes in the architecture of the mucosa that occur as the body’s immune response to the gluten protein.

Research objective: The main task is to confirm or refute the diagnosis of celiac disease by assessing the degree of damage to the small intestinal villi. This is extremely important, since the clinical symptoms of celiac disease (bloating, diarrhea, anemia) often overlap with other gastrointestinal diseases.

What does the pathologist assess (according to the Marsh-Oberhuber classification):

• Villi height: In celiac disease, the villi shorten (atrophy), which reduces the absorption surface of the intestine.

• Depth of crypts: assessment of depressions in the mucosa, which usually lengthen with disease (crypt hyperplasia).

• Interepithelial lymphocytes (IEL): counting the number of lymphocytes per 100 enterocytes. An increase in their number is the first sign of immune aggression against gluten.

• Villus/crypt ratio: a mathematical indicator that allows you to objectively determine the stage of the disease.

Clinical significance: Based on the study, the pathologist assigns a stage according to the classification Marsh:

• Marsh 0: normal mucous membrane.

• March 1: increase in the number of lymphocytes (infiltrative stage).

• Marsh 2: crypt elongation is added (hyperplastic stage).

• Marsh 3 (A, B, C): Partial or complete villous atrophy is a classic picture of celiac disease.

An accurate diagnosis allows the patient to begin a strict gluten-free diet, which is the only treatment that prevents the development of intestinal lymphomas and other serious complications.

When is it prescribed:

• positive results of specific blood tests (antibodies to tissue transglutaminase or endomysium);

• chronic diarrhea, steatorrhea (fatty stools), and weight loss;

• iron deficiency anemia resistant to treatment with iron preparations;

• growth and physical development delay in children;

• examination of relatives of patients with confirmed celiac disease.