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Abstract
Celiac Disease (CeD) is an immune-mediated inflammatory disorder of the small intestine, affecting genetically susceptible individuals when exposed to gluten. Small intestinal biopsy interpretation has been the “gold standard” for celiac disease (CeD) for over 50 years. Despite today’s availability of sensitive and specific serological tests, the histopathological features from mucosal biopsy play a key role in diagnosing when CeD is suspected. Such a diagnostic approach requires a multidisciplinary team to optimize both tissue sampling and interpretation via the interaction between the pathologist and the gastroenterologist. Pathologists of the Italian Group of Gastrointestinal Pathology (GIPAD-SIAPEC), together with a member (TR) of the Italian Society of Technicians (AITIC) and an expert gastroenterologist (CC), provide position statements as a practical tool for reading and interpreting the report.Moreover, a position statement was formulated about the recently described condition known as Non-Celiac Gluten Sensitivity (NCGS). Within such a diagnostic setting, both the architectural abnormalities of the duodenal mucosa, namely glandular hyperplasia, and villous atrophy and the number of intraepithelial T-lymphocytes should be well highlighted. Ancillary tests such as anti-CD3 stain are useful for an accurate count of the intraepithelial T lymphocytes when CeD or NCGS is suspected. Moreover, anti-CD3 and anti-CD8 stains are recommended in patients not responding to the gluten-free diet (GFD) to confirm a diagnosis of Refractory Celiac Disease (RCeD). Diagnostic clues about the differential diagnosis of both CeD and RCeD have also been rendered.
Highlights
Celiac disease (CeD) is an immune-mediated inflammatory disorder of the small intestine, affecting genetically susceptible individuals when exposed to gluten [1]
The prevalence of CeD is estimated to range from 0,2 to 1 worldwide, but it still remains largely underdiagnosed [2,3] or diagnosed with a significant delay [4,5,6,7]
The authors have reviewed the available literature about CeD diagnosis, using the MeSH Terms "anatomy and histology," "duodenum," and "celiac disease" and/or "diagnosis." The research produced 1323 papers, of which 984 according to the aim of the present study
Summary
Celiac disease (CeD) is an immune-mediated inflammatory disorder of the small intestine, affecting genetically susceptible individuals when exposed to gluten [1]. Sensitive and specific serological tests are nowadays available, a multidisciplinary approach to the clinical, serological, genetic, and histological features is recommended for the diagnosis of CeD. The growing shreds of evidence about diagnostic problems and pitfalls make necessary the formulation of position statements about the interpretation of the microscopic report, as to offer a practical and useful tool for pathologists and the non-specialized physicians. The major diagnostic hallmarks are here discussed and reviewed by a selected group of pathologists belonging to the Italian Group of Gastrointestinal Pathology (GIPAD-SIAPEC), with the collaboration of both an expert gastroenterologist (CC) and a member (TR) of the Italian Society of Technicians (AITIC), in order to define diagnostic key-points to provide a thorough histopathological report
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