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Against the Grain: Navigating Challenges in Celiac Disease Pathology
Juan Putra1, Jeffrey D Goldsmith1
1Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Surgical Pathology Clinics
|July 27, 2026
Summary
Accurate celiac disease diagnosis relies on integrating clinical, serologic, and histopathologic findings. Duodenal biopsy analysis, including villous atrophy and lymphocytosis, is crucial for diagnosis and patient care.
Area of Science:
- Gastroenterology
- Pathology
- Immunology
Background:
- Celiac disease diagnosis requires a multifaceted approach.
- Duodenal biopsy is a cornerstone for diagnosis, revealing key histologic features.
- Pathologic interpretation of biopsies involves specific criteria and ongoing discussions.
Purpose of the Study:
- To outline essential considerations for assessing histologic features in celiac disease diagnosis.
- To examine current controversies in the pathologic interpretation of duodenal biopsies.
- To discuss the evaluation of follow-up biopsies and the pathologist's role.
Main Methods:
- Review of established diagnostic criteria for celiac disease.
- Analysis of characteristic histopathologic findings: villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis.
- Discussion of diagnostic controversies, classification systems, and immunohistochemistry.
Main Results:
- Villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis are key indicators in duodenal biopsies.
- Ongoing debates exist regarding formal classification systems and the utility of immunohistochemistry.
- Proper evaluation of follow-up biopsies is critical for monitoring treatment response.
Conclusions:
- Histopathologic assessment of duodenal biopsies is indispensable for celiac disease diagnosis.
- Standardized interpretation and understanding of diagnostic controversies are vital.
- Pathologists play a critical role in ensuring accurate diagnosis and guiding patient management.
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