Celiac Disease
Modified Marsh Classification of histologic findings in celiac disease (Oberhuber)
| Marsh Type | IEL / 100 enterocytes – jejunum | IEL / 100 enterocytes - duodenum | Crypt hyperplasia | Villi |
| 0 | <40 | <30 | Normal | Normal |
| 1 | >40 | >30 | Normal | Normal |
| 2 | >40 | >30 | Increased | Normal |
| 3a | >40 | >30 | Increased | Mild atrophy |
| 3b | >40 | >30 | Increased | Marked atrophy |
| 3c | >40 | >30 | Increased | Complete atrophy |
- IEL/100 enterocytes, intraepithelial lymphocytes per 100 enterocytes
- Type 0: Normal; celiac disease highly unlikely.
- Type 1: Seen in patients on gluten free diet (suggesting minimal amounts of gluten or gliadin are being ingested); patients with dermatitis herpetiformis; family members of celiac disease patients, not specific, may be seen in infections.
- Type 2: Very rare, seen occasionally in dermatitis herpetiformis.
- Type 3: Spectrum of changes seen in symptomatic celiac disease.
Simplified systems may be more reproducible (Corazza, Roberts, Ensari)
- Grade A/Type 1: increased intraepithelial lymphocytes but no villous atrophy
- Seen in patients on gluten free diet (suggesting minimal amounts of gluten or gliadin are being ingested); patients with dermatitis herpetiformis; family members of celiac disease patients, not specific, may be seen in infections
- Grade B1/Type 2: villi still present but shortened
- Spectrum of changes seen in symptomatic celiac disease
- Grade B2/Type 3: complete villous atrophy
- Spectrum of changes seen in symptomatic celiac disease
