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Histopathology of celiac disease

Fei Bao1, Govind Bhagat

  • 1Department of Pathology and Cell Biology, Columbia University Medical Center and New York Presbyterian Hospital, New York, NY 10032, USA. fb2266@columbia.edu

Gastrointestinal Endoscopy Clinics of North America
|October 23, 2012
PubMed

Insights

Diagnosing celiac disease (CD) relies on small bowel biopsy. While intraepithelial lymphocytosis with villous atrophy is key, its presence without atrophy isn't specific to CD, highlighting the need for careful histopathologic assessment.

Area of Science:

  • Gastroenterology
  • Histopathology
  • Immunology

Background:

  • Small bowel biopsy is the gold standard for diagnosing celiac disease (CD).
  • Intraepithelial lymphocytosis accompanying villous atrophy is a hallmark of CD.
  • However, intraepithelial lymphocytosis alone, without villous atrophy, lacks specificity for CD and can occur in other small intestinal disorders.

Purpose of the Study:

  • To review the histopathologic assessment of small bowel biopsies for celiac disease diagnosis.
  • To discuss the influence of biopsy site and number on diagnostic accuracy.
  • To explore existing and novel classifications and the advantages of standardized pathology reports in diagnosing CD.

Main Methods:

  • Literature review focusing on histopathologic findings in celiac disease.
  • Analysis of studies examining the diagnostic utility of intraepithelial lymphocytosis and villous atrophy.
  • Evaluation of factors affecting diagnostic yield, including biopsy sampling and reporting standardization.

Main Results:

  • Villous atrophy combined with intraepithelial lymphocytosis is highly suggestive of celiac disease.
  • Intraepithelial lymphocytosis in the absence of villous atrophy is not pathognomonic for CD.
  • Biopsy site, number of samples, and standardized reporting impact diagnostic accuracy.

Conclusions:

  • Accurate histopathologic interpretation of small bowel biopsies is crucial for celiac disease diagnosis.
  • Standardized reporting and optimal biopsy sampling enhance diagnostic reliability.
  • Distinguishing CD from other conditions with similar histologic features requires careful evaluation.

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