Celiac Disease Biopsy Explained: Part I Villous Atrophy

The determination of celiac disease is confirmed by a characteristic abnormal appearance of the small intestine under the microscope. Flattening of the general finger like projections called villi accompanied by signs of inflammation is taken to indicate damage or injury from the storage protein gluten in wheat and similar proteins in barley and rye. The small intestine biopsy has became the gold thorough for establishing the determination of Celiac disease or gluten sensitive enteropathy. Before 1960 gluten resignation followed by revision and subsequent worsening upon rechallenge was the diagnostic criteria.

Early in the 1960's straight through the 1970's the small intestine was biopsied by having population swallow a small metal capsule that was attached to a suction tube. This was used to suction up tissue into the capsule before guillotining off some tissue once the capsule was confirmed to be in the small intestine by x-ray. Now the tissue is obtained by upper endoscopy, the tube of a lighted video scope straight through the mouth under sedation to the small intestine, where biopsies are obtained with cupped forceps.

Microscope

Celiac disease biopsy: What does the pathologist look for under the microscope?

The small intestine ordinarily has finger like projections called villi that give it a large covering area or sense area for absorption. The villi follow in a shag rug or terry cloth towel type appearance. Lining the covering covering of each villous are intestinal cells or enterocytes that secrete mucus and Ant. Eject fluids, nutrients, minerals like iron, and vitamins like B12. On the covering of the enterocytes are digestive enzymes like lactase that Ant. Eject lactose or milk sugar. At the base of the villi are crypts or circular like collections of intestinal cells.

Celiac disease biopsy: What is villous atrophy?

Normally, villi are 3-5 times longer than the crypts are tall. However, intestinal injury can follow in blunting, shortening (partial villous atrophy) or perfect loss of the villi and flattening (villous atrophy) of the intestinal surface. The shag rug will have bare spots or the terry cloth towel becomes like a tee shirt. The follow is lack of absorption of nutrients and water resulting in weight loss, malnutrition, and diarrhea.

Celiac disease biopsy: What if the biopsy does not show atrophy or partial atrophy?

If the villi are at least 3 times as long as the crypts are tall then no flattening or blunting of the villi is gift and celiac disease becomes more difficult for the pathologist to diagnose without the history or blood test results. However, an increased whole of Iel's (intra-epitheliel lymphocytes) in the setting of a obvious exact blood test for celiac, symptoms and especially if supported by proximity of Dq2 and/or Dq8 gene pattern, is highly suggestive of celiac disease. The strangeness comes when the blood tests for the exact tests are negative or not elevated but only the "non-specific" blood tests (anti-gliadin or Aga and anti-reticulin antibodies) are elevated. Also, some population with milder forms of celiac have no blood tests abnormal but have first-rate biopsy findings of celiac and are termed seronegative (blood test negative) celiacs.

Celiac disease biopsy: Can the biopsy be general in celiac disease?

By definition, the biopsy has been carefully the gold thorough for diagnosing celiac. However, recent studies have shown that the biopsy can be general in some population with celiac. How can this be? The pathologist reading the biopsy may illustrate the biopsy as general based on his or her bias about celiac disease, a failure to appreciate the point of the proximity of Iel's, or misuse of the older thorough of >40 Iel's per 100. However, more importantly is the recent recognition that general appearing biopsies may not be normal. Electron microscopy has revealed ultra-structural abnormalities in apparent general biopsies of population confirmed to have celiac disease. Extra stains, that consist of immune labeling of lymphocytes, have also confirmed increased numbers of obvious types of exact lymphocytes in the villi of intestinal biopsies of population confirmed to have celiac. The lowest line is that a general biopsy does not definitively exclude celiac disease or gluten sensitivity.

Celiac diasease biopsy: What are other possible causes of biopsy changes that mimic celiac disease?

Cow's milk protein sensitive enteropathy (Cmse), viral or bacterial infections, medications (especially aspirin like arthritis medications e.g. Ibuprofen etc), autoimmune enteropathy, Helicobacter pylori infection (the stomach ulcer bacteria), Aids, base variable immunodeficiency, and lymphoma of the intestine are all possible causes of small intestine changes that may mimic celiac. However, if you have first-rate celiac type symptoms, a obvious celiac exact antibody (anti-endomysial antibody or tissue transglutaminase antibody) and a obvious response to a gluten free diet then celiac is the likely cause. The likelihood is supplementary increased if you carry one or both of the two major genes linked with celiac disease, Dq2 and/or Dq8. Normalization of celiac exact blood tests and the biopsy after a gluten free diet confirms the determination of celiac disease.

Celiac Disease Biopsy Explained: Part I Villous Atrophy

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