Clinicopathological Spectrum of Duodenal Biopsies in Celiac Disease
DOI:
https://doi.org/10.21276/apalm.3867Keywords:
disease celiac, gluten sensitive enteropathy, celiac sprue, non-topical sprueAbstract
Background: This study was conducted to report all the clinico-pathological variations associated with celiac disease including many underreported microscopic features which can cause diagnostic confusions.
Methods: This retrospective cohort study included 27 cases of celiac disease. Laboratory findings, demographic and clinical features were noted. Histopathology slides of duodenal biopsy specimens were examined microscopically. Descriptive statistics were used to summarize the data. Chi-square test was used to study the association between the variables.
Result: The study included 15 males and 12 females (M:F = 1.2:1), with a mean age of 26.4 years (range: 2–54 years). Atypical manifestations, such as refractory anemia, short stature and hypoproteinemia were observed in 22.2% cases. Associated immunological disorders were observed in 40.7% of cases; most commonly type 1 diabetes mellitus (14.8%). Elevated serum IgA anti-tTG levels were noted in 96.3% of patients, excluding one with severe IgA deficiency. Endoscopic abnormalities were identified in 62.5% of cases. Histologically, 85.2% showed villous atrophy, with 70.4% in Marsh stage 3. Increased intraepithelial lymphocytes were noted in 74% of cases. Lamina propria showed varying degrees of lymphoplasmacytic, eosinophilic, and neutrophilic infiltration, showing correlation with the severity of villous atrophy (p value <0.05). Nine cases (33.3%) demonstrated surface epithelial changes. One case showed surface neutrophilic infiltrate.
Conclusion: Duodenal biopsies are recommended in suspected, serology-positive cases even without endoscopic changes. Celiac disease histology ranges from normal villi to variable villous blunting and increased intraepithelial lymphocytes. Additional epithelial or inflammatory changes may cause diagnostic pitfalls.
References
1. Villanacci, V., et al., Celiac disease: histology-differential diagnosis-complications. A practical approach. Pathologica, 2020. 112(3): p. 186.
2. Green, P.H., The many faces of celiac disease: clinical presentation of celiac disease in the adult population. Gastroenterology, 2005. 128(4): p. S74-S78.
3. Mohta, S., et al., Falsely elevated anti-tissue transglutaminase antibodies in patients with immunoproliferative small intestinal diseases: A case series. Indian Journal of Gastroenterology, 2023. 42(5): p. 713-717.
4. Bao, F., P.H. Green, and G. Bhagat, An update on celiac disease histopathology and the road ahead. Archives of pathology & laboratory medicine, 2012. 136(7): p. 735-745.
5. Volta, U., et al., The changing clinical profile of celiac disease: a 15-year experience (1998-2012) in an Italian referral center. BMC gastroenterology, 2014. 14(1): p. 194.
6. King, J.A., et al., Incidence of celiac disease is increasing over time: a systematic review and meta-analysis. Official journal of the American College of Gastroenterology| ACG, 2020. 115(4): p. 507-525.
7. Tharunika, S., et al., A narrative review of celiac disease in India with a focus on its link with type 1 diabetes. Journal of Diabetology, 2025. 16(1): p. 14-21.
8. Rawal, P., et al., Changing spectrum of celiac disease in India. Iranian Journal of Pediatrics, 2010. 20(4): p. 459.
9. Poddar, U., B.R. Thapa, and K. Singh, Clinical features of celiac disease in Indian children: are they different from the West? Journal of pediatric gastroenterology and nutrition, 2006. 43(3): p. 313-317.
10. Lal, S.B., et al., Clinical spectrum & changing presentation of celiac disease in Indian children. Indian Journal of Medical Research, 2023. 158(1): p. 75-84.
11. Tan, I.L., et al., Non-classical clinical presentation at diagnosis by male celiac disease patients of older age. European journal of internal medicine, 2021. 83: p. 28-33.
12. Li, T., et al., Causal relationships between autoimmune diseases and celiac disease: A Mendelian randomization analysis. Biotechnology and Genetic Engineering Reviews, 2024. 40(4): p. 4611-4626.
13. Perrotta, G., et al., Celiac disease: definition, classification, historical and epistemological profiles, anatomopathological aspects, clinical signs, differential diagnosis, treatments and prognosis. Proposed diagnostic scheme for celiac disease (DSCNC). Archives of Clinical Gastroenteroly, 2022. 8(1): p. 008-019.
14. Clemente, M.G., et al., Antitissue transglutaminase antibodies outside celiac disease. Journal of pediatric gastroenterology and nutrition, 2002. 34(1): p. 31-34.
15. Singaravel, S., R. Tandon, and P. Vohra, Morphological evaluation of bulb and distal duodenal biopsies in pediatric celiac disease with clinical and serological correlation. Indian Journal of Pathology and Microbiology, 2021. 64(3): p. 484-489.
16. Oberhuber, G., G. Granditsch, and H. Vogelsang, The histopathology of coeliac disease: time for a standardized report scheme for pathologists. European journal of gastroenterology & hepatology, 1999. 11(10): p. 1185.
17. Weir, D.C., et al., Variability of histopathological changes in childhood celiac disease. Official journal of the American College of Gastroenterology| ACG, 2010. 105(1): p. 207-212.
18. Wang, M., et al., Epidemiological, clinical, and histological presentation of celiac disease in Northwest China. World Journal of Gastroenterology, 2022. 28(12): p. 1272.
19. Singh, P., et al., Titers of anti-tissue transglutaminase antibody correlate well with severity of villous abnormalities in celiac disease. Journal of clinical gastroenterology, 2015. 49(3): p. 212-217.
20. Brown, I.S., J. Smith, and C. Rosty, Gastrointestinal pathology in celiac disease: a case series of 150 consecutive newly diagnosed patients. American journal of clinical pathology, 2012. 138(1): p. 42-49.
21. Kolman, O., et al., Neutrophilic infiltration in gluten sensitive enteropathy (GSE): a series of 100 pediatric patients. Modern Pathology, 2010. 23(S1): p. 152A-152A.
22. Owen, D.R. and D.A. Owen, Celiac disease and other causes of duodenitis. Archives of pathology & laboratory medicine, 2018. 142(1): p. 35-43.
23. Brown, I., M. Bettington, and C. Rosty, The role of histopathology in the diagnosis and management of coeliac disease and other malabsorptive conditions. Histopathology, 2021. 78(1): p. 88-105.
24. Collins, M.H., Histopathology associated with eosinophilic gastrointestinal diseases. Immunology and allergy clinics of North America, 2009. 29(1): p. 109-117.
25. De Re, V., et al., Galectin‐10, eosinophils, and celiac disease. Annals of the New York Academy of Sciences, 2009. 1173(1): p. 357-364.
26. Alharbi, E., et al., A Deep Learning–Based Approach to Estimate Paneth Cell Granule Area in Celiac Disease. Archives of Pathology & Laboratory Medicine, 2024. 148(7): p. 828-835.
27. Di Sabatino, A., et al., Distribution, proliferation, and function of Paneth cells in uncomplicated and complicated adult celiac disease. American journal of clinical pathology, 2008. 130(1): p. 34-42.
28. Ilus, T., et al., Incidence of malignancies in diagnosed celiac patients: a population-based estimate. Official journal of the American College of Gastroenterology| ACG, 2014. 109(9): p. 1471-1477.
29. Mehta, S., et al., Impact of delay in the diagnosis on the severity of celiac disease. Journal of Gastroenterology and Hepatology, 2024. 39(2): p. 256-263.
30. Chen, Z.E., H.E. Lee, and T.-T. Wu, Histologic evaluation in the diagnosis and management of celiac disease: practical challenges, current best practice recommendations and beyond. Human Pathology, 2023. 132: p. 20-30.
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