Diagnosing celiac disease: A critical overview

Area of Science:

• Gastroenterology
• Immunology
• Pathology

Background:

• Celiac disease (CD) diagnosis has evolved beyond malabsorption and severe lesions.
• The Marsh classification, based on biopsy, identifies gluten-induced mucosal changes and immune responses.
• This classification expanded diagnostic criteria, enabling more patients to access gluten-free diets.

Purpose of the Study:

• To evaluate the clinical utility of the Marsh classification in diagnosing celiac disease.
• To assess the impact of Marsh subclassification on diagnosis, treatment, and prognosis.
• To explore future diagnostic approaches for celiac disease.

Main Methods:

• Review of the Marsh classification's historical development and application in celiac disease diagnosis.
• Analysis of the immunopathological spectrum of gluten-induced mucosal changes.
• Consideration of emerging diagnostic techniques and research areas.

Main Results:

• The Marsh classification broadened diagnostic criteria, allowing more patients access to gluten-free diets.
• Revisions to the Marsh classification have not improved interpretation of mucosal pathology.
• Marsh 3 subclassification adds workload for pathologists without aiding clinical decisions.

Conclusions:

• Gastroenterologists often disregard Marsh 3 subclassification, suggesting its reporting is unnecessary.
• New diagnostic methods, including molecular techniques and stem cell research, may be needed for evaluating mucosal pathology in CD.
• Pathologists should reconsider reporting Marsh 3 subclassification given its limited clinical impact.