The Value of Ensari’s Proposal in Evaluating the Mucosal Pathology of Childhood Celiac Disease: Old Classification versus New Version

Year 2012, Volume: 2012 Issue: 3, 281 - 284, 01.03.2012

Servet Güreşci Şamil Hızlı Gülçin Güler Şimşek

https://doi.org/10.5152/balkanmedj.2012.016

Abstract

Objective: Small intestinal biopsy remains the gold standard in diagnosing celiac disease (CD); however, the wide spectrum of histopathological states and differential diagnosis of CD is still a diagnostic problem for pathologists. Recently, Ensari reviewed the literature and proposed an update of the histopathological diagnosis and classification for CD. Materials and Methods: In this study, the histopathological materials of 54 children in whom CD was diagnosed at our hospital were reviewed to compare the previous Marsh and Modified Marsh-Oberhuber classifications with this new proposal. Results: In this study, we show that the Ensari classification is as accurate as the Marsh and Modified Marsh classifications in describing the consecutive states of mucosal damage seen in CD. Conclusions: Ensari's classification is simple, practical and facilitative in diagnosing and subtyping of mucosal pathology of CD Turkish Anahtar Kelimeler: Çöyak Hastalığı, Marsh Sınıflaması, Modifiye Marsh-Oberhuber sınıflaması, Ensari sınıflaması Amaç: Çölyak hastalığı (ÇH) tanısında ince barsak biyopsisi altın standard değerini korumakla birlikte ÇH'nın geniş histopatolojik yelpazesi ve ayırıcı tanısı patologlar için hala tanısal bir problemdir. Yakın zamanda Ensari literatürü gözden geçirerek ÇH histopatolojik tanı ve sınıflaması için yeni bir öneri sunmuştur. Materyal ve Metod: Hastanemizde tanı almış 54 pediatrik ÇH olgusunun patoloji arşiv materyali Marsh, Modifiye Marsh-Oberhuber sınıflaması ve Ensari önerisine göre yeniden değerlendirilmiştir. Sonuç: Ensari önerisi basit, pratik ve aynı zamanda ÇH tanı ve mukozal subtiplemesinde kolaylaştırıcı bulunmuştur.

Keywords

Celiac disease, marsh classification, modified Marsh-Oberhuber classification, Ensari classification

The Value of Ensari’s Proposal in Evaluating the Mucosal Pathology of Childhood Celiac Disease: Old Classification versus New Version

Abstract

References

• Brown I, Mino-Kenudson M, Deshpande V, Lauwers GY. Intraepi- thelial lymphocytosis in architecturally preserved proximal small intestinal mucosa: an increasing diagnostic problem with a wide differential diagnosis. Arch Pathol Lab Med 2006;130:1020-5.
• Rubin CE, Brandborg LL, Phelps PC, Taylor HC Jr. Studies of ce- liac disease.I. The apparent identical and specific nature of the duodenal proximal jejunal lesion in celiac disesase and idiopathic sprue. Gastroenterology 1960;38:28-49.
• Marsh MN. Gluten, major histocompatibility complex, and small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (‘celiac sprue’). Gastroenterology 1992;102:330-5
• Dickson BC, Streutker CJ, Chetty R. Coeliac disease: an update for pathologists. J Clin Pathol 2006;59:1008-16. [CrossRef]
• Oberhuber G, Granditsch G, Vogelsang H. The histopathology of celiac disease: time for a standardized report scheme for pathol- ogists. Eur J Gastroenterol Hepatol 1999;11:1185-94. [CrossRef]
• Ensari A. Gluten-sensitive enteropathy (celiac disease): con- troversies in diagnosis and classification. Arch Pathol Lab Med 2010;134:826-36.
• Revised criteria for diagnosis of coeliac disease. Report of Work- ing Group of European Society of Pediatric Gastroenterology and Nutrition. Arch Dis Child 1990; 65: 909-11. [CrossRef]
• Wells WA, Carney PA, Eliassen MS, Grove MR, Tosteson AN. Pa- thologists’ agreement with experts and reproducibility of breast ductal carcinoma-in-situ classification schemes. Am J Surg Pathol 2000;24:651-9. [CrossRef]
• Balamtekin N, Uslu N, Baysoy G, Usta Y, Demir H, Saltik-Temizel IN, et al. The presentation of celiac disease in 220 Turkish chil- dren. Turk J Pediatr 2010;52:239-44.
• Kuloglu Z, Kirsaclioglu CT, Kansu A, Ensari A, Girgin N. Celiac disease: presentation of 109 children. Yonsei Med J 2009;50:617-23. [CrossRef]
• Ertekin V, Selimoglu MA, Kardas F, Aktas E. Prevalence of celiac disease in Turkish children. J Clin Gastroenterol 2005;39:689-91. [CrossRef]
• Corazza GR, Villanaci V. Coeliac disease. J Clin Pathol 2005;58:573-4. [CrossRef]
• Weile B, Hansen BF, Hagerstrand I, Hansen JP, Krasilnikoff PA. Interob- server variation in diagnosing coeliac disease. A Joint study by Danish and Swedish pathologists. APMIS 2000;108:380-4. [CrossRef]
• Di Sabatino A, Corazza GR. Coeliac disease. Lancet 2009;373:1480-93. [CrossRef]
• Veress B, Franzen L, Bodin L, Borch K. Duodenal intraepithelial lympho- cyte-count revisited. Scand J Gastroenterol 2004;39:138-44. [CrossRef]
• Hayat M, Cairns A, Dixon MF, O’Mahony S. Quantitaion of in- traepithelial lymphocytes in human duedonum: what is normal? J Clin Pathol 2002;55:393-4. [CrossRef]
• Pellegrino S, Villanacci V, Sansotta N, Scarfì R, Bassotti G, Vieni G, et al. Redefining the intraepithelial lymphocytes threshold to diagnose gluten sensitivity in patients with architecturally normal duodenal histology. Aliment Pharmacol Ther 2011;33:697-706. [CrossRef]
• Biagi F, Bianchi PI, Campanella J, Zanelatti G, Corazza GR. The impact of misdiagnosing celiac disease at a referral centre. Can J Gastroenterol 2009;23:543-5.
• Brown I, Kenudson MM, Deshpande V, Lauwers GY. Intraepithe- lial lymphocytosis in architecturally preserved proximal small in- testinal mucosa: an increasing diagnostic problem with a wide differential diagnosis. Arch Pathol Lab Med 2006;130:1020-5.
• Mahadeva S, Wyatt JI, Howdle PD. Is a raised intraepithelial lym- phocyte count with normal duodenal villus architecture clinically relevant? J Clin Pathol 2002;55:424-8. [CrossRef]
• Goldstein NS. Proximal small bowel mucosal villous intraepithe- lial lymphocytes. Histopathology 2004;44:199-205. [CrossRef]
• Biagi F, Luinetti O, Campanella J, Klersy C, Zambelli C, Villanacci V, et al. Intraepithelial lymphocytes in the villous tip: do they indicate potential celiac disease? J Clin Pathol 2004;57:835-9. [CrossRef]