INVITED REVIEW CONTROVERSIAL ISSUE - CAN DUODENAL MUCOSA APPEAR NORMAL IN GLUTEN-SENSITIVE ENTEROPATHY (CELIAC-DISEASE)

Increasing popularity of serologic and permeability studies in patient s investigated for possible celiac disease has resulted in a growing a wareness among clinicians that currently accepted histologic criteria for diagnosis of celiac disease lack sensitivity. The patients who imp rove on a gluten-free diet with abnormal findings from serologic and p ermeability studies may have normal or ''almost'' normal villous/crypt morphology. The population of intraepithelial lymphocytes once extens ively discussed in the literature may after all prove useful in identi fying the individuals who may benefit from dietary gluten withdrawal. A recently outlined spectrum of the mucosal pattern (M. N. Marsh), whi ch may be seen in the gluten-sensitive enteropathy is valuable in asse ssing histomorphology of small bowel biopsies from the patients invest igated for celiac disease.