Celiac Disease

Himali Meshram
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INVESTIGATIONS
1. Positive anti-TTG (transglutaminase) or anti-EMA (endomysial antibody) in blood
2. HLA Testing for HLA-DQ2 and HLA-DQ8-Typing
3. Histological Analysis of Duodenal Biopsies
Biopsies should be taken preferably during upper endoscopy from the bulb (at least 1 biopsy) and from the second or third portion of duodenum (at least 4 biopsies).

Modified Marsh classification: Histological analysis of the duodenal biopsies is done and categorized into 3 types based. Any type of 3 indicates symptomatic celiac disease. However, types 1 and 2 may also indicate celiac disease.

Table : Modified Marsh Classification
  TYPE 0 TYPE 1 TYPE 2 TYPE 3A TYPE 3B TYPE 3C
IEL < 40 > 40 > 40 > 40 > 40 > 40
CRYPTS Normal Normal Hypertrophic Hypertrophic Hypertrophic Hypertrophic
VILLI Normal Normal Normal Mild atrophy Marked atrophy Absent

IEL : intra epethlial lymphocytes/100 epithelial cells.


Celiac Disease Celiac Disease 09/04/2018
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