Marsh Classification Research Articles

Can flow cytometry be a key in the difficult diagnosis of coeliac disease?

We present the clinical case of a 39-year-old woman with a medical history of juvenile idiopathic arthritis and uveitis, evaluated for abdominal pain and distension, difficulty gaining weight, and diarrhea. Blood tests were requested, including antibodies which were negative and common genetic markers, showing positivity for HLA DQ 7.5. A gastroscopy with duodenal biopsies revealed findings consistent with stage 3b of the modified Marsh classification. Due to diagnostic uncertainty, an IEL study was performed, showing a characteristic CD pattern, leading to the initiation of a strict gluten-free diet (GFD). During follow-up, the patient showed partial improvement, with persistent digestive symptoms. A repeat endoscopic study revealed persistent atrophy, but refractory disease type 2 was ruled out. During a flare of rheumatologic disease, Tocilizumab was initiated by Rheumatology, resulting in improvement of duodenal atrophy.

Anti-tissue transglutaminase antibody correlation with severity of villous abnormalities in celiac disease: A Systematic Review and Meta-analysis

Abstract Introduction/Objective Celiac disease (CD) is a long-term autoimmune disorder that affects individuals genetically predisposed to gluten intolerance. Biomarkers, particularly anti-tissue transglutaminase antibody (anti-tTG ab), are crucial in indicating disease states and have potential as non-invasive substitutes for mucosal biopsies in assessing the severity of intestinal damage. This study aims to systematically review and analyze the correlation between anti- tTG antibody levels and the severity of villous abnormalities in patients with celiac disease to evaluate the potential of anti-tTG as a non-invasive diagnostic tool. Methods/Case Report Following PRISMA guidelines, a comprehensive literature search selected 15 studies focusing on the correlation between anti-tTG antibodies and villous atrophy. Systematic data extraction and quality assessments were performed, followed by statistical analyses to determine the strength and consistency of associations. Results (if a Case Study enter NA) Analysis of data from four studies on anti-tTG antibody positivity revealed a nearly significant pooled effect size (p = 0.06) with considerable heterogeneity (I^2 = 97%, p < 0.00001). Additionally, data from five studies using the MARSH classification of histological damage, aggregated using a random-effects model, showed overall statistical significance (Z = 3.36, p = 0.0008). Conclusion Anti-tTG antibodies serve as a reliable indicator of villous damage in CD, supporting their dual utility in diagnosis and monitoring. High anti-tTG antibody titers could potentially eliminate the need for invasive biopsy procedures in certain patient subsets, underscoring the promise of more refined and non-invasive diagnostic approaches, although further research is needed to address the implications of high heterogeneity observed in the studies.

Positive association of serum IgG4 levels with modified marsh classification system in children with gluten enteropathy: a single centre experience

Background: Celiac disease or gluten enteropathy is an immune-mediated systemic disorder elicited by gluten and related prolamines in genetically susceptible individuals and is characterized by the presence of gluten enteropathy, celiac disease-specific antibodies, HLA-DQ2/DQ8 haplotypes. IgG4-related diseases is an increasingly recognized immune-mediated condition in autoimmune disorders such as primary sclerosing cholangitis, autoimmune hepatitis, and autoimmune thyroiditis, characterized by tissue fibrosclerosis and infiltration by IgG4-positive plasma cells and increased serum IgG4 concentrations. Methods: A total of 33 children with newly diagnosed celiac disease and 31 control subjects were included in this study. All suspected celiac disease children underwent duodenal biopsy and were diagnosed based on Marsh grading. Serum IgG4 level estimations were performed using an enzyme-linked immune sorbet assay method with a cut-off of 135 mg/dl for diagnosis. Results: A significant positive association between serum IgG4 levels and Marsh classification was found, the higher the levels of IgG4 in serum, the higher the grade on Marsh staging. Mean serum IgG4 levels in Marsh 3a was 126.32 mg/dl, in 3b was 171.35 mg/dl and in 3c was 209.24 mg/dl (p value=0.004) Conclusions: With increasing serum IgG4 levels, increased severity of damage was seen on biopsy specimens based on higher Marsh grade. To the best of found knowledge, this is the first study to establish the relation between IgG4 and mucosal damage in children with celiac disease.

Vitamin D and celiac disease.

Celiac disease (CD) is an immune-mediated condition affecting the small intestine. Its reported global prevalence falls within the range of 0.7% to 1.4%. Notably, historically, higher rates, reaching 1% in Western Ireland, have been documented. Recent research has even revealed prevalence rates as elevated as 2% in northern Europe. These findings underscore the urgency for swift and cost-effective diagnosis, especially in individuals identified through screening efforts. At present, the diagnosis of CD relies on a multifaceted approach involving positive serological markers such as IgA anti-tissue transglutaminase (anti-TTG) and anti-endomysial antibodies (anti-EMA). These serological findings are assessed in conjunction with classical histological alterations, as outlined in the Marsh classification. CD is an inflammatory condition triggered by the consumption of gluten, resulting from intricate interactions between genetic, immunological, and environmental factors. CD is linked to malabsorption, leading to nutritional deficiencies. Individuals with CD are required to adhere to a gluten-free diet, which itself can lead to nutrient deficiencies. One such deficiency includes vitamin D, and there is substantial experimental evidence supporting the notion of a bidirectional relationship between CD and vitamin D status. A low level of vitamin D has a detrimental impact on the clinical course of the disease. Here we summarize the key characteristics of CD and explore the prominent roles of vitamin D in individuals with CD.

Thyroid diseases in children and adults with celiac disease: A cross-sectional study.

There are few reports evaluating different factors, including the severity of duodenal histopathological findings and serological levels of celiac disease (CD), in increasing the probability of thyroid diseases (TD) in adults and children with CD, so, we designed this research. CD was defined as Marsh type 2 or higher in duodenal histopathology and serological levels of anti-transglutaminase antibodies (anti-tTG) equal to or greater than 18 IU/ml. To assess the likelihood of TD in CD patients, logistic regression analysis was employed. 538 patients were included in this study. Of these, 354 (65.8%) were females and 184 (34.2%) were males. 370 (68.8%) patients were children. Overall, 57 (10.6%) patients had TD, of which 49 (9.1%) had hypothyroidism and 8 (1.5%) had hyperthyroidism. Adults had a significantly higher probability of developing TD than children (OR 1.9; 95% CI 1.1-3.4; P = 0.03). The odds of developing TD were also significantly higher in patients with family marriage in parents (OR 2.3; 95% CI 1.1-4.7; P = 0.03). Other variables such as gastrointestinal symptoms, anti-tTG levels, and severity of Marsh classification did not exhibit a substantial rise in the likelihood of TD development. The study findings indicated that the likelihood of developing TD in CD patients can be linked to advancing age and having family marriage in parents, while there was no significant association observed with anti-tTG levels, severity of histological damage, and gastrointestinal symptoms.

Celiac disease diagnosis: transglutaminase, duodenal biopsy and genetic tests correlations.

Celiac disease (CD) is an autoimmune enteropathy triggered by gluten ingestion in genetically susceptible individuals. The haplotypes HLA-DQ2 and DQ8, transglutaminase (TGA) antibodies, and biopsy findings are the main tests performed in the evaluation and CD diagnosis. The objective was to establish possible correlations between transglutaminase levels, genetic markers tests, and qualitative intestinal biopsy findings (modified Marsh classification) at the diagnosis. A retrospective cohort study. The selection criteria were confirmed CD cases with genetic tests performed. Statistical analysis was done mainly through One-way ANOVA, Kendall's correlation coefficient (T), and linear regression. The study included 112 patients, with a mean age of 6 ± 4 years. All cases were tested to HLA-DQ2, and it was positive in 93%. HLA-DQ8 was tested in 73% of cases and it was positive in 61%. The percentage of negative genetic markers (DQ2/DQ8) was 4.5% for patients tested to both haplotypes. A comparison of DQ2/DQ8 (positive and negative) with clinical findings and tests performed did not identify any differences for most of the parameters analyzed. Cases of type I diabetes presented significant negative expression for DQ2(-); p = 0.05 and positive expression for DQ8(+); p = 0.023. The TGA antibody levels ranged from 18 to 36,745 U/ml. An inverse correlation was found between age and TGA-L level (p = 0.043). In 23% of the cases, the TGA levels were greater than 1,000 U/ml and presented a moderate positive correlation with the atrophy biopsy profile (T = 0.245). Patients with an atrophic biopsy profile (Marsh III) had a moderate positive correlation with growth failure (T = 0.218) but a negative correlation with constipation (T = -0.277). In terms of diagnosis tests for CD, transglutaminase levels and age presented an inverse correlation, with the level decreasing as age increased. A moderately positive correlation was found between mean transglutaminase with intestinal atrophy and growth retardation. The genetic test DQ2 was positive for 93% and negative genetic markers (DQ2/DQ8) represented 4.5% of cases studied.

Combination of super-resolution reconstruction and SGA-Net for marsh vegetation mapping using multi-resolution multispectral and hyperspectral images

ABSTRACT Vegetation is crucial for wetland ecosystems. Human activities and climate changes are increasingly threatening wetland ecosystems. Combining satellite images and deep learning for classifying marsh vegetation communities has faced great challenges because of its coarse spatial resolution and limited spectral bands. This study aimed to propose a method to classify marsh vegetation using multi-resolution multispectral and hyperspectral images, combining super-resolution techniques and a novel self-constructing graph attention neural network (SGA-Net) algorithm. The SGA-Net algorithm includes a decoding layer (SCE-Net) to precisely fine marsh vegetation classification in Honghe National Nature Reserve, Northeast China. The results indicated that the hyperspectral reconstruction images based on the super-resolution convolutional neural network (SRCNN) obtained higher accuracy with a peak signal-to-noise ratio (PSNR) of 28.87 and structural similarity (SSIM) of 0.76 in spatial quality and root mean squared error (RMSE) of 0.11 and R2 of 0.63 in spectral quality. The improvement of classification accuracy (MIoU) by enhanced super-resolution generative adversarial network (ESRGAN) (6.19%) was greater than that of SRCNN (4.33%) and super-resolution generative adversarial network (SRGAN) (3.64%). In most classification schemes, the SGA-Net outperformed DeepLabV3 + and SegFormer algorithms for marsh vegetation and achieved the highest F1-score (78.47%). This study demonstrated that collaborative use of super-resolution reconstruction and deep learning is an effective approach for marsh vegetation mapping.

Frequency of Celiac Disease among Children with Type I Diabetes Mellitus

Background: Type 1 diabetes mellitus (T1DM) is a metabolic condition of chronic hyperglycemia due to a lack of insulin resulting from the autoimmune destruction of pancreatic beta cells. T1DM is associated with many autoimmune conditions, especially hypothyroidism and celiac disease (CD). Objective: To determine the frequency of celiac disease among children and adolescents with type 1 diabetes mellitus. Study Design: Prospective cross-sectional study. Settings: Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Child Health Sciences, The Children’s Hospital, Lahore Pakistan. Duration: October 2019 to January 2022. Methods: A total of 150 children and adolescents with T1DM were included in this study. Patients already diagnosed with CD, patients with concomitant autoimmune disease, patients with Down syndrome, and patients who refused to participate and who lost follow-up were excluded from the study. All patients underwent a celiac screen, and those with positive or borderline serology had an endoscopic biopsy of the distal duodenum. Biopsy reporting was done as per Modified Marsh Classification. The patient's data and laboratory findings were recorded through a predesigned proforma and analyzed using SPSS version 20. Results: The mean age of participants was 8.08 ± 2.95 years, including 79 (52.7%) male and 71 (47.3%) female patients. A total of 19 (12.7%) had positive serology for celiac disease, and 8 (5.3%) had biopsy findings confirming celiac disease. Conclusion: Children and adolescents with T1DM have an increased tendency for CD, warranting earlier screening for timely detection and management.

Pixel-based unique phenological feature composite method: tackle the challenges of Spartina alterniflora identification and salt marsh classification in mixed vegetations area

Coastal salt marshes are valuable wetland ecosystems, and obtaining accurate information on their spatial and temporal distribution is crucial. However, due to the strong spectral similarity among various types of salt marshes, distinguishing them is difficult, especially in areas with mixed salt marsh growth. In this study, we developed a pixel-based unique phenological feature composite method (PUpf-CM). First, we identified a unique phenological period for each type of salt marsh by analyzing the normalized difference vegetation index time-series of Spartina alterniflora (S. alterniflora) and native salt marshes [Suaeda salsa (S. salsa), Phragmites australis (P. australis), and Imperata cylindrica (I. cylindrica)] in Yancheng National Nature Reserve, Jiangsu Province, China. Then, we generated a composite image for each unique phenological period, maximizing the spectral separability between the corresponding salt marsh and background species. Second, we used the composite images obtained at the unique phenological period of S. alterniflora as input to the random forest classifier, achieving high precision identification of S. alterniflora. Compared with the previously developed pixel-based PUpf-CM, the overall accuracy (OA) of PUpf-CM was 98.26% to 99.42%, and the Kappa was 0.940 to 0.975, indicating an improvement of 0.87% to 4.94% and 0.031 to 0.179, respectively. Finally, we tested the possibility of applying PUpf-CM to salt marsh classification by stacking four composite images obtained at different unique phenological periods. We found that the maximum spectral separability was achieved for the combination of four unique phenological periods, and the OA and Kappa of the PUpf-CM-based salt marsh classification reached 97.54% and 0.969, respectively.

Celiac Disease in Syrian Children and Adolescents with Type 1 Diabetes Mellitus: A Cross-Sectional Study

Abstract Introduction Celiac disease (CD) is highly prevalent in patients with type 1 diabetes mellitus (T1DM). However, the rate of CD in Syrian children and adolescents with T1DM is unknown. We aimed to investigate the prevalence and characteristics of CD in our unprivileged rural community. Methods Children and adolescents with T1DM who were regularly followed in a private endocrine clinic in Raqqa City, Syria, were evaluated from October 2018 to November 2021. Screening for CD was performed using either anti-tissue transglutaminase antibodies, antideaminated gliadin antibodies, or endomysial antibodies. Patients with positive results were referred for duodenal biopsy using Marsh classification whenever possible. The prevalence of CD was calculated for both seropositive and biopsy-proven cases. Results Ninety-four patients with T1DM, 51 (54.3%) females, were included. The mean age was 11.6 years, and mean hemoglobin A1c (HbA1C) was 9.2%. All patients were screened for CD. Fourteen patients (14.9%) were positive, and seven (7.4%) performed a duodenal biopsy that proved positive for CD in all cases. CD seropositivity was more common in female than male patients (21.6 vs. 7%, respectively, p-value <0.05). Patients with seropositivity for CD had lower hemoglobin levels compared to seronegative patients, with a mean difference of 0.87 (95% confidence interval: 0.2–1.5; p-value <0.05). There was a statistically significant correlation between hypothyroidism and celiac seropositivity (p-value <0.05). There were no differences in age, weight, height, HbA1C, puberty status, or duration of diabetes between patients with and without CD. No correlation was identified between the incidence of hypoglycemia or diabetic ketoacidosis and the presence of CD. Conclusion In our community, we revealed a high prevalence of CD in Syrian children and adolescents with T1DM. Our results are alarming and point to the need for establishing a national CD registry to prompt physicians for proper screening and early management in high-risk populations.

Serum positivity of serum anti-tissue transglutaminase immunoglobulin A antibodies in Japanese children with inflammatory bowel disease.

Serum anti-tissue transglutaminase immunoglobulin A antibody (tTG-IgA) is a screening test for celiac disease (CeD). In recent years, there have several reports of combined inflammatory bowel disease (IBD) and CeD in children. The purposes of this study are to research the positivity of the tTG-IgA antibody in Japanese children, and whether IBD and CeD co-occur. We examined tTG-IgA as a screening test for CeD in symptomatic pediatric patients with IBD (cases) and those without IBD (controls, non-IBD). Those with tTG-IgA levels of 10U/mL or higher were considered positive. All patients had routine biopsy specimens taken from the second part and bulbus of the duodenum, and were evaluated histologically based on the Marsh classification. Thirty-one patients in the IBD group and 53 patients in the non-IBD group were included. The tTG-IgA was positive in five cases (5.9%) and median titer of positive cases was 12.3U/mL (10.2-41.7). One patient in the IBD group (3.2%) and four patients in the non-IBD group (7.8%) were positive for tTG-IgA. No cases showed histological features of CeD. There were no statistically significant differences in age, sex, symptoms and laboratory tests between the tTG-IgA positive and negative groups. Patients among the IBD and the non-IBD groups that were tTG-IgA positive demonstrated symptoms after wheat consumption. We identified a patient who was positive for tTG-IgA antibodies who experienced abdominal symptoms due to wheat ingestion, indicative of subclinical CeD. Further investigation is needed to clarify the co-occurrence of IBD and CeD among Japanese children.

Relationship between villous atrophy and Wnt pathway gene expressions in pediatric celiac patients

Celiac disease is an autoimmune disease characterized by an abnormal immune response occurring in the small intestine linked to consumption of food containing gluten in individuals with a genetic predisposition. Dysregulation of Wnt signal transduction plays a role in the pathogenesis of many diseases including autoimmune diseases like celiac disease. In this study, the correlation of Wnt pathway gene expressions with each other and the correlation with clinical data were researched in pediatric celiac disease cases grouped according to the Marsh classification. Gene expression levels of FZD8, DVL2, LRP5, RHOA, CCND2, CXADR, and NFATC1, which are involved in the Wnt pathway, were determined using quantitative real-time polymerase chain reaction in 40 celiac disease and 30 healthy individuals. All cases with the short height symptom were observed to be in Marsh 3b\3c groups (p=0.03). The gene expressions of DVL2, CCND2, and NFATC1 were high in the Marsh 3b group, and these genes showed positive correlation with each other (p=0.002). LRP5 and CXADR gene expressions were lower in the Marsh 3b group compared to other Marsh groups, and these genes showed a positive correlation with each other (p=0.003). CCND2 gene expression was associated with Marsh 3b group, diarrhea, and vomiting symptoms. DVL2 gene expression was correlated with Marsh 2 group and constipation symptom (p<0.05). Wnt signaling in the early stages of the disease of Marsh 1-2 involves high expression of LRP5 and CXADR genes, while expression of these two genes reduces, and DVL2, CCND2, and NFATC1 gene expressions clearly increase with a transduction variation observed from Marsh 3a stage when villous atrophy begins to form. It appears that the Wnt pathway may contribute to disease progression through expression changes.

Factors Affecting Prognosis in the Course of Pediatric Celiac Disease.

Introduction Celiac disease (CD) is a rather frequent chronic autoimmune disease that causes impaired growth in children. The present study aims to evaluate patients' condition after diagnosis cross-sectionally and determine the factors affecting prognosis. Methods Control visits were performed at the end of the 13-month intervention period. The study was designed as a single-center retrospective study and included patients diagnosed with CD. The study cohort consisted of 211 patients aged 1 to 18 years. Statistical parameters include Helicobacter positivity, Marsh classification; economic status; and body mass index (BMI) z-score, weight z-score, and height z-score to observe the difference between admission and follow-up. Results Treatment adherence is one of the most critical factors influencing improvement in developmental parameters during control visits (p<0.033). It was observed that the weight z-scores at the control visit deteriorated significantly with a longer duration of complaints (p=0.033). Better improvement of control visit BMI z-scores among patients with complaints compared to asymptomatic patients (p=0.036) indicate the importance of early diagnosis in asymptomatic cases. Developmental parameters of patients with CD without growth retardation (GR) show faster improvement compared to patients with GR (p<0.001). Families with good socioeconomic status can easily adapt to the diet by reaching a greater variety of gluten-free products, so anthropometric measurements are observed to be significantly higher at the control visit (p<0.002). Conclusions Treatment adherence is the most critical factor for improvement in CD treatment, as in all treatments. In addition, the investigation of suspected, additional disease symptoms during the follow-up of a CD patient is also of great importance for early diagnosis. The importance of early diagnosis has been emphasized in terms of anthropometric improvement in asymptomatic CD cases.

"Long-term follow-up and prognosis of celiac hepatitis".

Celiac disease has been associated with abnormal liver function tests at diagnosis that usually resolve with a gluten-free diet (GFD). The aim of this study was to assess the evolution of liver involvement and possible long-term complications in patients on a GFD. Retrospective and single-center study, which included all individuals with Celiac disease followed in specialized consultation in a tertiary referral hospital. A total of 162 patients were included, most of them female (77.8%) with a median age of 24 years (IQR, 7-39). Seventy-four (45.7%) patients had abnormal liver function tests at diagnosis. These individuals had higher anti-tissue transglutaminase IgA (tTG-IgA) antibody titers (126 vs. 29 IU/L; P = 0.003). There were no significant differences in the Marsh classification ( P = 0.599). During follow-up, most celiac hepatitis patients had normalization of liver function tests and tTG-IgA antibodies. At the last follow-up, all the patients had fibrosis-4 index &lt;2.4 and an aspartate aminotransferase-to-platelet ratio index score &lt;0.6. Vibration-controlled transient elastography showed values &lt;6.4 kPa in all cases. On the other hand, it was found that 42.9% of the individuals had a controlled attenuation parameter &gt;206.5 db/m. In our cohort, liver function tests normalized in the vast majority of celiac hepatitis patients on a GFD, with no progression to chronic liver disease. It should be noted the high number of individuals who present hepatic steatosis during follow-up, which may be related to a diet that tends to be hyperlipidemic and hypercaloric.

Elevated interleukin-17A levels despite reduced microRNA-326 gene expression in celiac disease patients under gluten-free diet.

Introduction: The microRNA-326 (miR-326) gene, by targeting ETS Proto-Oncogene 1 (ETS1), regulates the differentiation and interleukin-17A production of T helper 17 (Th17) cells. Celiac disease (CD) is an intestinal autoimmune disorder, in which the cascade of Th17 cells plays an important role in its pathogenicity. The aim of this study was to evaluate the expression changes of miR-326 and its two target genes ETS1 and IL-17A in celiac disease patients under a gluten-free diet (GFD). We expected the expression of miR-326 and IL-17A gene to decrease, and the expression of the ETS1 gene to increase, following the adherence to GFD. Methods: Peripheral blood samples of 40 CD patients under GFD (for more than 1 year) and 40 healthy individuals were collected. RNA was extracted, cDNA was synthesized and the miR-326, ETS1 and IL-17A gene expressions were evaluated by the quantitative polymerase real-time qPCR method. P-value ˂ 0.05 was considered statistically significant. Results: Although miR-326 mRNA expression was significantly lower in CD patients (P = 0.001), no significant difference was observed in ETS1 mRNA level between the two groups (P = 0.54), but IL-17A was significantly overexpressed in CD patients (P=0.002). No significant correlation was observed between the expression of the studied genes and the patients' symptoms and Marsh classification. Conclusion:Adherence to the GFD for one to two years did not have the expected effect on the expression of genes in this panel. The most important finding that contradicted our hypothesis was the observation of high IL-17A levels in CD patients despite dieting, which may be related to the protective effect of this cytokine on intestinal tight junctions, which needs to be confirmed in further studies.

Celiac Disease Investigation with Marsh Classification in Paediatric Population

Objective: To determine the celiac disease using Marsh classification in the paediatric population at the Pak Emirates Military Hospital.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital Rawalpindi Pakistan, from Aug 2020 till Mar 2021.&#x0D; Methodology: Patients of either gender aged 1 to 14 years with three or more clinical features of celiac disease such as chronic diarrhoea, any degree of malnutrition, short stature, abdominal distension, anaemia, and clubbing at the time of admission, were included in this study.&#x0D; Results: There were 97 patients in this study. Among them, 61 (62.9%) were males, and 36 (37.1%) were females. There were 56 (57.7%) patients who were histology positive and 41 (42.3%) patients who were histology negative. There were 37 (38.1%) patients in Marsh III a, 15 (15.5%) were in Marsh III b, and 4 (4.1%) patients were in the Marsh III c category. Gender distribution showed that 33 (58.9%) males were positive compared to 23 (41.1%) females. Even though the frequency was higher among males, the difference was not statistically significant (p-value=0.23).&#x0D; Conclusion: Celiac disease is a possible reason for anaemia among patients with iron deficiency anaemia of unknown origin. Therefore, the histopathological diagnosis should be completed when celiac disease is suspected.

Immunohistochemical analysis of intestinal biopsies in individuals with celiac disease.

Background and AimsThe immunohistochemical application of CD3 (T lymphocytes) and CD20 (B lymphocytes) markers in duodenal biopsy can facilitate the detection of the number and distribution of intraepithelial lymphocytes along the villi, which is regarded as a key factor for accurate diagnosis of celiac disease. This study aims at finding a relationship between CD3 and CD20 immunohistochemical and histopathological alterations of celiac disease, and at investigating whether the application of those immunohistochemical stainings would improve the detection of lymphocytosis within the epithelium and add advantages to celiac disease diagnosis.MethodsBiopsies were obtained from 100 individuals and stained with hematoxylin and eosin (H&E). They were then evaluated according to the Marsh classification. After that, staining for CD3 and CD20 was individually done and assessed.ResultsThe overall mean intraepithelial lymphocyte count per 100 enterocytes for H&E was 23.1 (95% confidence interval [CI] = 19.52–26.68), and for immunohistochemistry by CD3 and CD20 was 27.84 (95% CI = 24.31–31.38). The difference was highly significant, P = 0.001. The expression of CD3 immunohistochemically was as follows: Less‐than‐half staining pattern was reported in 16% cases, and half staining pattern was seen in 26%, while most cases 58% had more than half staining pattern. This discovery was consistent with the histological classification of March III among most cases. The expression of CD20 immunohistochemically was as follows: mild crypt involvement was observed in 16% of cases, while moderate crypt involvement and intense crypt involvement were seen in 43% and 41% of cases, respectively.

Comparison of the Lactobacillus and Bifidobacterium Population in Fecal Microbiome of Celiac Disease Patients on Gluten-Free Diet With Healthy Subjects

Aims Celiac disease (CD) is a chronic autoimmune disease triggered by gluten and other environmental factors, such as intestinal microbiota in genetically predisposed persons. This study aimed to evaluate the composition of the target gut microbiota population in patients with CD and to compare it with healthy individuals. Methods &amp; Materials In this case-control study, Bifidobacterium and Lactobacillus were evaluated in the fecal samples of 20 celiac patients on a gluten-free diet (GFD) with 20 healthy individuals referred to the Celiac Disease Department, Tehran, Iran, from August 2019 to February 2020. Microbial DNA extracted from fecal samples was evaluated by specific primer pairs using the real-time-polymerase chain reaction (PCR) technique. Statistical analysis was performed using IBM SPSS Statistics version 21. Findings The results of the demographic information of participants regarding the gender and the mean age as well as the Marsh classification showed no statistically significant difference between the two groups (P&gt;0.05). The comparison of intestinal microbiota between the two study groups revealed that the rate of Bifidobacterium spp. and Lactobacillus spp. was significantly lower in celiac patients compared to the control group. Conclusion The results of this study confirmed the dysbiosis in celiac patients compared to healthy subjects. In addition, changes in the gut microbiome may contribute to the pathogenesis of the CD.

Platelet Indices in Determination of Marsh Classification in New Diagnosed Celiac Patients

Platelet Indices in Determination of Marsh Classification in New Diagnosed Celiac Patients

Frequency of Celiac Disease Diagnosed on Endoscopic Duodenal Biopsy in Patients of Functional Dyspepsia

Objective: To determine the frequency of celiac disease diagnosed on endoscopic duodenal biopsy in patients presenting with functional dyspepsia. Methods: This was a cross-sectional study was conducted at the Department of Gastroenterology and Hepatology, Shalamar Medical and Dental College, Lahore. A total 160 patients of either gender, aged 20-70 years and diagnosed with functional dyspepsia were included. The study was conducted during a period of six months from September 2021 to February 2022. The informed consent of patients was obtained. All the basic demographic information of each patient was noted and all the patients underwent endoscopic duodenal biopsies and specimens were sent to the department of histopathology for the histopathological assessment of celiac disease. The collected data were analyzed statistically by using SPSS version 12. Results: Average age of male and female patients was 45.61±14.41 and 39.83±14.91 years. Among 160 patients 60(37%) were male and 100(63%) were females. There were 90(56.3%) patients who had dysmotility like dyspepsia, 54(33.8%) patients diagnosed with an ulcer like dyspepsia and 16(10%) patients were having unspecified dyspepsia. According to the Marsh classification, 140 patients were diagnosed with type-0, 7 patients with Type-1, 2 patients with type-2, 9 patients with type-3a and 2 patients with type-3b. Celiac disease was diagnosed with the help of Modified Marsh classification. Among 160 patients 13(8%) were diagnosed with celiac disease. Conclusion: The results of the current study show a high frequency of celiac disease in patients with functional dyspepsia. Keeping this fact in mind, silent/subclinical CD should be kept in mind as a cause of functional dyspepsia during clinical activities Keywords: Celiac disease, Endoscopic duodenal biopsy, Functional dyspepsia