Celiac Disease: New Guidelines for Diagnosis and Management

David A. Johnson, MD


August 21, 2013

In This Article

Confirmatory Testing for Celiac Disease

Confirmatory testing is done through duodenal biopsies.

Biopsies are assessed according to histologic criteria, which include the Marsh criteria and the Corazza criteria. The criteria include crypt hyperplasia, interim epithelial lymphocytes, and villous atrophy. These findings are graded by the pathologist and reported to us. The Corazza criteria are probably the most current, but many of you are more familiar with the Marsh criteria. However, if you don't deliver the right specimens and the right tissue, the pathologist could be somewhat limited.

When doing a diagnostic endoscopy, how many biopsy samples should be taken, and from where? The evidence is very strong now. The previous recommendation was to take 4 biopsies from the second and third portions of the duodenum. Now you must include the duodenal bulb. If you don't biopsy the duodenal bulb, you would miss 9%-13% of patients who have clear evidence of celiac disease.

One or 2 biopsies from the duodenal bulb coupled with 4 or more biopsies from the second and third portions of the duodenum are submitted to pathology. The pathology results come in, and indicate villous atrophy. This is categorized by the different criteria, which should lead to the correct diagnosis.


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