The result of a small bowel biopsy for the diagnosis of celiac disease is determined by what are called the Marsh criteria. Dr. Krishtina Sardi Gastroenterologist, prof Buda Allergy Center Your doctor was asked about the study and assessed the results.
If a person suspects that their complaint may be related to gluten consumption, a serological test is performed as the first step. The result of a blood sample is always compared to the patient’s complaints, that is, it cannot be said that a person does not have celiac disease, although there are complaints. In this case, the investigation must be continued, and the next step is to perform a biopsy of the small intestine. This is also done with a positive laboratory result, because in addition to the serological tests, a biopsy is required to diagnose celiac disease.
What does the study show?
– During gastric reflection, the endoscope is passed through the stomach into the initial stage of the small intestine. Swelling, watery mucous membranes, rough folds, or flat folds in the small intestine may indicate celiac disease. A sample of the intestinal mucosa will be examined during a biopsy of the small intestine anatomically, Dr. Krishtina Sardi.
Photo: Vadym Terelyuk / Getty Images Hungary
The celiac immune system produces autoantibodies to the proteins (gluten) in wheat, barley, and rye. Autoantibodies cause intestinal inflammation and damage to the intestinal wall. The inflammation damages and flattens the intestinal villi in the small intestine, a change that can be seen in the tissue sample.
Marsh and the numbers
The results of the histological samples are evaluated on a scale from 0 to 4 according to severity, based on the pooling determined by pathologist Michael N. Marsh. The Marsh value equal to 0 is the negative result, if we see this, the condition of the intestinal mucosa is normal. Marsh 1 and 2 indicate inflammation, and Marsh 3 actually shows shortening of the intestinal villi.
There are several subgroups here depending on the extent of partial or complete damage. And Marsh 4 is a rare but serious finding that indicates complete atrophy of the intestinal villi.
Contradictory results?
Dr. Krisztina Sárdi draws attention to the fact that it is very important to assess the results of individual examinations and the patient’s symptoms together, that only in this way can an appropriate diagnosis be made. In fact, it may seem paradoxical for a patient to receive a Marsh score of 0 in addition to positive sera, and this is called latent celiac disease. Another case is silent celiac disease, in which no symptoms appear, the serology is positive, and the villi damage occurs “unnoticed”.
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This process can be reversed with a gluten-free diet. The third case when all tests are negative but the patient has symptoms related to gluten consumption. In this case, he or she will start eating a gluten-free meal on the advice of your doctor and monitor you for any improvement. If so, a non-celiac gluten sensitivity, NCGS is the diagnosis.
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(Image source: Getty Images Hungary.)
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