CLINICAL AND SYSTEMATIC REVIEWS: REVIEWMeasuring Change In Small Intestinal Histology In Patients With Celiac DiseaseAdelman, Daniel C MD1; Murray, Joseph MD2; Wu, Tsung-Teh MD, PhD3; Mäki, Markku MD, PhD4; Green, Peter H MD5; Kelly, Ciarán P MD6Author Information 1Department of Medicine, Division of Allergy and Immunology, University of California, San Francisco, San Francisco, CA, USA 2Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA 3Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA 4Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland 5Celiac Disease Center, Columbia University, New York, NY, USA 6Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA Correspondence: Ciarán P. Kelly, MD, Celiac Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, DANA-601, Boston, MA 02215, USA. E-mail: email@example.com published online 20 February 2018 SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A297, http://links.lww.com/AJG/A298, http://links.lww.com/AJG/A299 Received 11 April 2017; accepted 2 October 2017 American Journal of Gastroenterology: March 2018 - Volume 113 - Issue 3 - p 339-347 doi: 10.1038/ajg.2017.480 Buy SDC Metrics Abstract Small intestinal histologic abnormalities in celiac disease include atrophy of the intestinal villi, hypertrophy of the crypts and lymphocytic infiltration of intraepithelial spaces and lamina propria. These findings are central to diagnosis and their severity and change over time are valuable to monitor disease course and response to therapy. Subjective methods to grade celiac disease histological severity include the Marsh-Oberhuber and Corazza-Villanacci systems. Quantitative histology uses villus height (Vh), crypt depth (Cd), and intra-epithelial lymphocyte count (per 100 enterocytes) to provide objective measures of histologic changes including Vh:Cd ratio. Here we examine the available literature regarding these methodologies and support the use of quantitative histology as the preferred method for accurately and reproducibly demonstrating change of relevant histologic end points over time. We also propose a Quantitative-Mucosal Algorithmic Rules for Scoring Histology (Q-MARSH) system to partially align quantitative histology results with the traditional Marsh, Marsh-Oberhuber, and Corazza-Villanacci systems. Q-MARSH can provide a standardized, objective, and quantitative histology scoring system for use as a clinical or research application. © The American College of Gastroenterology 2018. All Rights Reserved.