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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 from duodenal biopsies. Pathologists play a crucial role in interpreting these findings for optimal patient care.
Area of Science:
- Gastroenterology
- Pathology
- Immunology
Background:
- Celiac disease diagnosis requires a multidisciplinary approach.
- Duodenal biopsy is a cornerstone for diagnosis, revealing specific histological changes.
- Accurate interpretation of biopsy findings is critical for patient management.
Purpose of the Study:
- To outline key considerations in assessing histologic features of celiac disease.
- To examine controversies in the pathologic interpretation of duodenal biopsies.
- To discuss the role of immunohistochemistry and follow-up biopsies in celiac disease assessment.
Main Methods:
- Review of histopathologic findings in celiac disease.
- Analysis of diagnostic criteria including villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis.
- Discussion of current controversies in pathologic interpretation and diagnostic tools.
Main Results:
- Villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis are key diagnostic indicators.
- Ongoing debates exist regarding classification systems and the routine use of immunohistochemistry.
- Evaluation of follow-up biopsies presents specific challenges.
Conclusions:
- Histopathologic assessment of duodenal biopsies is essential for celiac disease diagnosis.
- Standardized interpretation and understanding of diagnostic controversies are vital.
- Pathologists are integral to accurate diagnosis and effective patient care in celiac disease.
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