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Measuring Change In Small Intestinal Histology In Patients With Celiac Disease

Adelman, Daniel C MD1; Murray, Joseph MD2; Wu, Tsung-Teh MD, PhD3; Mäki, Markku MD, PhD4; Green, Peter H MD5; Kelly, Ciarán P MD6

American Journal of Gastroenterology: March 2018 - Volume 113 - Issue 3 - p 339–347
doi: 10.1038/ajg.2017.480

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.

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:

published online 20 February 2018

SUPPLEMENTARY MATERIAL accompanies this paper at,,

Received 11 April 2017; accepted 2 October 2017

© The American College of Gastroenterology 2018. All Rights Reserved.
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