Comparison the modified Marsh classification, The clinical symptoms and laboratory parameters in coeliac disease (CD)

Abstract

Background: The incidence of coeliac disease (CD) is increased in the latest years. Patients haven't had serious gastrointestinal symptoms at all and it is diagnosed often delayed. The diagnosis of CD is based on intestinal biopsy evaluated by Marsh classification and presence of antitissue transglutaminase (TTG) antibody. Aim: To compare the symptoms, the laboratory parameters and the pathological description based on Marsh classification. Patients and methods: All patients who were diagnosed by histopatology classified mucosal mild (Marsh3a), moderate (Marsh3b) or complete (Marsh3c) atrophy of villi. This staging was compared with the gastrointestinal symptoms, the antitissue transglutaminase (TTG) antibody positivity and other laboratory parameters. Results: The total number of the cases in the 5 years (2005–2010) were 186 (female: 161, male: 25). The mucosal atrophy graded by Marsh score: 78/186 (42%) of the patients belong to Marsh3a, 44/186 (24%) to Marsh3b and 64/186 (34%) to Marsh3c group, respectively. The main symptoms of 136/186 (73%) patients were diarrhoea, abdominal pain, but 50/186 (27%) patients were symptoms free. According to Marsh classification: 58/78 (74%) of the patient with Marsh3a, 32/44 (73%) with Marsh3b and 46/64 (72%) with Marsh3c noticed the main symptoms, while 20/78 (26%) of the patients with Marsh3a, 12/44 (27%) with Marsh3b and 18/64 (28%) with Marsh3c were symptoms free. The antitissue transglutaminase (TTG) antibody were negative 13/78 (16%) in patients with Marsh3a atrophy, and much lower (2.3–1.5%) negative results were found in the patients with Marsh3b and 3c group. There was high improvement in clinical symptoms 54/58 (93%) in the patients with Marsh3a same as group Marsh3b,c on gluten free diet. Conclusion: There is no difference in the severity of the mucosal atrophy between the group with gastrointestinal symptoms and symptoms free patients. But the higher rate of TTG negative cases in Marsh3a group shows that the gold standard of the diagnosis of CD is unalterably the histological examination. On the clinical basic the indication of gluten free diet and the follow-up in the group Marsh3a is similar then in the other groups.