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Predictive value of "Marsh 1" type histology in subjects with suspected cealic disease
Raffaella Tortora1, Pietro Capone, Nicola Imperatore
1Department of Clinical Medicine and Surgery - University of Naples "Federico II", Gastroenterology , Naples , Italy.
Insights
Marsh 1 histology, often used for celiac disease (CD) diagnosis, has a 36% positive predictive value. This finding suggests Marsh 1 is not specific for CD and can indicate other conditions.
Area of Science:
- Gastroenterology
- Pathology
- Immunology
Background:
- Celiac disease (CD) diagnosis relies on histology and serology (anti-tissue transglutaminase and anti-endomysial antibodies).
- Marsh 1 histology, characterized by increased intraepithelial lymphocytes, is a key diagnostic feature but its specificity for CD is questioned.
Purpose of the Study:
- To determine the positive predictive value (PPV) of Marsh 1 histology in individuals suspected of having celiac disease.
- To evaluate the clinical relevance and specificity of Marsh 1 histology in the context of celiac disease diagnosis.
Main Methods:
- An observational prospective study included 63 consecutive patients with Marsh 1 histology.
- Patients underwent testing for anti-tissue transglutaminase (a-tTG) and anti-endomysial antibodies (EMAs).
- Clinical data including symptoms, family history of CD, comorbidities, and medications were collected.
Main Results:
- Marsh 1 histology had a PPV of 36% for potential celiac disease (Marsh 1 with positive a-tTG and EMAs).
- Patients with potential CD had a significantly higher frequency of family history for CD (60.8% vs. 15.0%).
- No significant differences in symptoms were observed between CD and non-CD groups. Other conditions like autoimmune diseases (17.5%), Helicobacter pylori infection (12.5%), and medication use were noted.
Conclusions:
- Marsh 1 histology is not specific for celiac disease.
- Marsh 1 histology can be associated with other conditions, including autoimmune disorders, H. pylori infection, and certain medications.
Introduction:
The diagnosis of celiac disease (CD) is based on histology in combination with anti-tissue transglutaminase (a-tTG) and anti-endomysial antibodies (EMAs). The increase of intraepithelial lymphocytes defines the Marsh 1 histology that appears not to be specific for CD.
Aim:
To explore the positive predictive value (PPV) and clinical relevance of Marsh 1 histology in suspected CD.
Methods:
We carried out an observational prospective study including all consecutive subjects with a Marsh 1 histology. All patients were tested for a-tTG and EMAs. Diagnosis of potential CD was defined in the presence of Marsh 1 with positive a-tTG and EMAs. Patients were investigated for symptoms, CD familial aggregation, other diseases, and current medication.
Results:
Sixty-three patients with Marsh 1 were included. Diagnosis of potential CD was made in 23 subjects (36%), so that Marsh 1 histology showed a PPV of 36%. With regard to familial aggregation, patients with potential CD showed a higher frequency of familiarity for CD (60.8% vs. 15.0%; p < 0.01). No significant difference was detected between CD and non-CD in terms of intestinal and extra-intestinal symptoms. We also documented the presence of conditions other than CD in the remaining population: 7 patients (17.5%) with immuno-mediated diseases while 5 patients (12.5%) showed Helicobacter pylori (HP) infection. About medication, 3 patients (7.5%) were on non-steroidal anti-inflammatory drugs, while another 4 (10%) patients were being treated with other drugs.
Conclusion:
The Marsh 1 type histology is not specific for CD and it can also be associated with immuno-mediated disorders, HP infection, and drugs.
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