A study of clinical, serological and histopathological profile in celiac disease

Background: Celiac disease (CD), is a chronic immune-mediated disorder of small intestine that occurs in genetically predisposed populations. It is characterized by permanent intolerance to wheat gliadins and other cereal prolamins. The epidemiology of CD has iceberg characteristics¬ with more undiagnosed cases. The pathogenesis entails a T cell‐mediated immune response with production of autoantibodies directed against tissue transglutaminase or endomysium. The diagnosis of CD is currently based on both typical small bowel biopsy findings with clinical and serological parameters. Aims: This study conducted with aims to classify the endoscopic duodenal biopsies using modified Marsh grading in cases of suspected celiac disease and compare these grades with various clinical and serological parameters including serum tTG levels. Setting and Design: Biopsies from second part of duodenum in total of 100 consecutive cases of suspected CD (on the basis of clinical and serological profile) formed the study group. Marsh grades were compared with anti-tTG levels, hemoglobin, endoscopy, and clinical presentations. Materials and Methods: Histopathological diagnosis was established on routine haematoxylin and eosin stained sections. The histopathological grading was performed as per modified Marsh grading. Representative section was also subjected for immunohistochemical staining with antihuman CD3 antibody for evaluating intraepithelial lymphocytes. Comparison of these grades with the serological (anti tTg levels) and other clinical parameters (symptoms, weight, endoscopy and hemoglobin levels) were done. Statistical Analysis: These data were subsequently analysed using SPSS 20.0 software. Chi square test and other relevant statistics were used to assess the relationship between two variables. P-value less than 0.05 was accepted as statistically significant. Results and Conclusions: Majority of patients presented with typical gastrointestinal symptoms and significantly correlated with higher Marsh grades (p= 0.0326) but atypical symptoms can be the primary presentation of the disease. Patients with higher serum anti-tTG levels, have a high-degree probability of duodenal damage. Anti-tTG levels have conclusively been proven to correlate with increasing histological grades (p=0.005). So, in selected conditions with strong clinical suspicion and high titres of anti tTG, a duodenal biopsy may be avoided especially in children and it could be the basis to prescribe a GFD.