How is celiac disease (sprue) histologically graded?

Updated: Nov 29, 2019
  • Author: Stephan U Goebel, MD; Chief Editor: BS Anand, MD  more...
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Upper endoscopy with at least 6 duodenal biopsies is considered the criterion standard to help establish a diagnosis of celiac disease. Histologically, duodenal biopsies can be graded into the following 5 stages:

  • Stage 0 - Normal

  • Stage 1 - Increased percentage of intraepithelial lymphocytes (>30%)

  • Stage 2 - Increased presence of inflammatory cells and crypt cell proliferation with preserved villous architecture

  • Stage 3 - Mild (A), moderate (B), and subtotal to total (C) villous atrophy

  • Stage 4 - Total mucosal hypoplasia

See Workup for more detail.

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