Diagnosis of celiac disease and sprue - Recommendations of the German Society for Pathology Taskforce on Gastroenterological Pathology

The diagnosis of celiac disease (CD) is based upon histological findings in duodenal or jejunal biopsy specimens. In recent years it has been seen tha t the development of CD lesion in the small bowel is a dynamic process whic h may present in Various histological forms. At one end of the spectrum is a mucosa with normal architecture and an increase in intraepithelial lympho cytes; at the other end is the classical flat mucosa. Histological features supporting the diagnosis of CD are architectural changes of the villi and/ or crypts, an increase in lamina propria cell density, and an increase in i ntraepithelial lymphocytes counts. Exact histological classification of the histological findings is required for diagnostic purposes and for monitori ng of CD patients. This has become possible by using a modified Marsh class ification. We present both the histological presentation of CD and the modi fied Marsh classification,and the most important differential diagnoses.