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Modified Marsh Classification of the Duodenal Biopsies of a Large Database Covering 10 Years

Year 2014, Volume: 39 Issue: 1, 61 - 69, 22.07.2014
https://doi.org/10.17826/cutf.20314

Abstract

Purpose: Celiac is an autoimmune disease caused by of gluten proteins which can be found in multi-grain food like wheat, barley and oat. The disease affects more than 1% of population and characterized by intestinal inflammation. In celiac disease, mucosal damage is a dynamic process. It is shown that it has autoimmune components. It is also T-Cell mediated and can be categorised as a chronic inflammatory disease. The purpose of this study is to make modified Marsh classification of the duodenal biopsies that came to our department in the 10 years. The study deals with reassessment of all events and uncovering the low graded events that were not diagnosed. Material and Methods: 467 biopsies (diagnosed between 2001 and 2011 at the Cukurova University, Faculty of Medicine, Department of Pathology) were taken and analyzed by two pathologists. Each sample was reevaluated without taking the previous reports into consideration and scored by using modified Marsh classification. Results: According to Modified Marsh Classification total of 48 cases were diagnosed as Type 1. Total of 6 cases according to Modified Marsh Classification was diagnosed as Type 2. Total of 11 cases according to Modified Marsh Classification was diagnosed as Type 3a. Total of 5 cases, according to Modified Marsh Classification, was diagnosed as Type 3b. Total of 6 cases according to Modified Marsh Classification was diagnosed as Type 3c. Conclusion: As a result of this study, it has been found that Modified Marsh Classification is a very important standardization tool for detection of suspicious duodenal biopsies and for early case examinations.

References

  • Rodrigo L. Celiac disease. World J Gastroenterology. 2006;12:6585-93.
  • Wilson PP, Donald R, Duerksen MD, et al. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastrointest Endosc. 2008;67:1082-7.
  • Schuppan D. Current concepts of celiac disease pathogenesis. Gastroenterology. 2000;119-234.
  • Alaedini A, Green PHR. Narrative review: celiac disease: understanding a complex autoimmune disorder. Ann Intern Med. 2005;142:289–98.
  • Cecilia MF. Gastrointestinal pathology an Atlas Taex. Chapter 6; 476. Walker M, Talley N.J. Pathology – Research and Practice. 2011;207:538–44.
  • National Institutes of Health Consensus Development Conference Statement on Celiac Disease, June 28– 30, 2004, Gastroenterology. 2005,128:1–9.
  • Owens SR, Greenson JK. The pathology of malabsorption: current concepts, Histopathology. 2007;50:64–82.
  • Upton MP. Give us this day our daily bread – evolving concepts in celiac sprue. Arch. Pathol. Lab. Med. 2008;132:1594–9.
  • Mavromichalis J, Brueton MJ, McNeish AS. Anderson CM. Evaluation of the intraepithelial lymphocyte count in the jejunum in childhood enteropathies, Gut. 1976;17:600–3.
  • Dickson BC, Streutker CJ, Chetty R. Coeliac disease: an update for pathologists, J. Clin. Pathol. 2006 59:1008–16.
  • Marsh MN. Grains of truth: evolutionary changes in small intestinal mucosa in response to environmental antigen challenge. Gut. 1990;31:111-4.
  • Nelson KLI, Texbooks of pediatrics 330. 2 GlutenSensitive Enteropathy (Celiac Disease). Bonamico M, Mariani P, Thanasi E, et al. Patchy villous atrophy of the duodenum in childhood celiac disease. J Pediatr Gastroenterol Nutr. 2004;38:204-7.
  • Scott BB, Losowsky MS. Patchiness and duodenaljejunal variation of the mucosal abnormality in coeliac disease and dermatitis herpetiformis. Gut. 1976;17:984-92.
  • Fubara ES, Freter R: Protection against enteric bacterial infection by secretory IgA antibodies. J Immunol 1973;111:395
  • Hill PG, Holmes GK. Coeliac disease: a biopsy is not always necessary for diagnosis. Aliment Pharmacol Ther 2008;27:572-77.
  • Catassi C, Mph MD, Fasano A. Celiac Disease Diagnosis: Simple Rules Are Better Than Complicated AlgorithmsThe American Journal of Medicine 2010;123(8).
  • Dandalides SM, Carey WD, Peters R, et al. Endoscopic small bowel mucosal biopsy: a controlled trial evaluating forceps size and biopsy location in the diagnosis of normal and abnormal mucosal architecture. Gastrointest Endosc 1989;35:197-200.
  • Segal HG, Petras RE. Small intestine, in: S.S. Sternberg (Ed.), Histology for Pathologists, Lippincott-Raven, 1997;495–518.
  • Collin P, Wahab PJ. Murray JA. Intraepithelial lymphocytes and coeliac disease. Best Pract. Res. Clin. Gastroenterol. 2005;19:341–50.
  • Wahab PJ, Meijer JW., Mulder CJ. Histologic followup of people with celiac disease on a gluten-free diet: slow and incomplete recovery, Am. J. Clin. Pathol. 2002;118:459–63.
  • Biagi F, Luinetti O. Campanella J. et al. Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease? J. Clin. Pathol. 2004;57:835–9.
  • Walkera MM, Talley NJ. Clinical value of duodenal biopsies – Beyond the diagnosis of coeliac disease. Pathology – Research and Practice. 2011;207:538– 44
  • Maki M, Holm K, Collin P, Savilahti E. Increase in gamma/delta T cell receptor bearing lymphocytes in normal small bowel mucosa in latent coeliac disease, Gut. 1991;32:1412–4.
  • McGowan KE, Lyon ME, Butzner JD. Celiac disease and IgA deficiency: complications of serological testing approaches encountered in the clinic, Clin. Chem. 2008;54:1203–9.
  • Hopper AD, Hadjivassiliou M, Hurlstone DP, et al. What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis, Clin. Gastroenterol. Hepatol. 2008;6:314–
  • Ferguson A, Murray D. Quantitation of intraepitelial lymphocytes in human jejeunm. Gut 1971;12:988.
  • Dib HH, Lu SQ, Wen SF. Prevalence of Giardia lamblia with or without diarrhea in South East South East Asia and the Far East, Parasitol. Res. 2008;103:239–51.
  • Oberhuber G, Kastner N, Stolte M, Giardiasis: a histologic analysis of 567 cases, Scand. J. Gastroenterol. 1997;32:48–51.
  • Yazışma Adresi / Address for Correspondence: Dr. Cansu Abaylı Çukurova University, Faculty of Medicine, Department of Pathology Sarıçam, ADANA Email: cabayli@mynet.com geliş tarihi/received :22.08.2013 kabul tarihi/accepted:24.09.2013

On Yılı Kapsayan Duedonal Biyopsi Kayıtlarının Modifiye Marsh Klasifikasyonu

Year 2014, Volume: 39 Issue: 1, 61 - 69, 22.07.2014
https://doi.org/10.17826/cutf.20314

Abstract

Amaç: Çöliak hastalığı, buğday, arpa ve yulaf gibi tahıllı gıdalarda bulunan, gluten proteinleri ile oluşan, toplumun %1 inden fazlasının etkilendiği, ince barsak enflamasyonu ile karekterize otoimmün bir hastalıktır. Çöliak hastalığında mukozal hasar, otoimmün kompenenti olan, aynı zamanda T hücre aracılı, kronik enflamatuvar hastalık olarak kabul edilen, dinamik bir süreçtir. Bu çalışmanın amacı, 10 yıl içerisinde bölümümüze gelen duedonal biopsilere Modifiye Marsh Klasifikasyonunu uygulamaktır. Bu çalışmanın amacı, daha önce tespit edilemeyen düşük dereceli çöliak olgularının ortaya çıkarılmasıdır. Materyal ve Metod: 467 biopsi alındı ve 2 patolog tarafından değerlendirildi (2001 ile 2011 yılları arasında Çukurova Üniversitesi Tıp Fakültesi, Patoloji anabilim dalında tanıları konuldu). Her bir örnek daha önce rapor edilen tanılar göz önüne alınmaksızın yeniden değerlendirildi. Bulgular: Modifiye Marsh Klasifikasyonuna göre 48 olgu Tip 1 çöliak tanısı konuldu. Modifiye Marsh Klasifikasyonuna göre 6 olguya Tip 2 çöliak tanısı konuldu. Toplam 11 olguya Modifiye Marsh Klasifikasyonuna göre Tip3a çöliak tanısı konuldu. Toplam 5 olguya Modifiye Marsh Klasifikasyonuna göre Tip 3b çöliak tanısı konuldu. Toplam 6 olguya Modifiye Marsh Klasifikasyonuna göre Tip 3c çöliak tanısı konuldu. Sonuç: Bu çalışma, Modifiye Marsh Klasifikasyonunun klinik şüpheli olgularda duedonal biopsilerin değerlendirilmesinde önemli bir standartizasyon getirdiğini, erken olguların değerlendirilmesinde çok yararlı olduğunu ortaya koymuştur.

References

  • Rodrigo L. Celiac disease. World J Gastroenterology. 2006;12:6585-93.
  • Wilson PP, Donald R, Duerksen MD, et al. How many duodenal biopsy specimens are required to make a diagnosis of celiac disease? Gastrointest Endosc. 2008;67:1082-7.
  • Schuppan D. Current concepts of celiac disease pathogenesis. Gastroenterology. 2000;119-234.
  • Alaedini A, Green PHR. Narrative review: celiac disease: understanding a complex autoimmune disorder. Ann Intern Med. 2005;142:289–98.
  • Cecilia MF. Gastrointestinal pathology an Atlas Taex. Chapter 6; 476. Walker M, Talley N.J. Pathology – Research and Practice. 2011;207:538–44.
  • National Institutes of Health Consensus Development Conference Statement on Celiac Disease, June 28– 30, 2004, Gastroenterology. 2005,128:1–9.
  • Owens SR, Greenson JK. The pathology of malabsorption: current concepts, Histopathology. 2007;50:64–82.
  • Upton MP. Give us this day our daily bread – evolving concepts in celiac sprue. Arch. Pathol. Lab. Med. 2008;132:1594–9.
  • Mavromichalis J, Brueton MJ, McNeish AS. Anderson CM. Evaluation of the intraepithelial lymphocyte count in the jejunum in childhood enteropathies, Gut. 1976;17:600–3.
  • Dickson BC, Streutker CJ, Chetty R. Coeliac disease: an update for pathologists, J. Clin. Pathol. 2006 59:1008–16.
  • Marsh MN. Grains of truth: evolutionary changes in small intestinal mucosa in response to environmental antigen challenge. Gut. 1990;31:111-4.
  • Nelson KLI, Texbooks of pediatrics 330. 2 GlutenSensitive Enteropathy (Celiac Disease). Bonamico M, Mariani P, Thanasi E, et al. Patchy villous atrophy of the duodenum in childhood celiac disease. J Pediatr Gastroenterol Nutr. 2004;38:204-7.
  • Scott BB, Losowsky MS. Patchiness and duodenaljejunal variation of the mucosal abnormality in coeliac disease and dermatitis herpetiformis. Gut. 1976;17:984-92.
  • Fubara ES, Freter R: Protection against enteric bacterial infection by secretory IgA antibodies. J Immunol 1973;111:395
  • Hill PG, Holmes GK. Coeliac disease: a biopsy is not always necessary for diagnosis. Aliment Pharmacol Ther 2008;27:572-77.
  • Catassi C, Mph MD, Fasano A. Celiac Disease Diagnosis: Simple Rules Are Better Than Complicated AlgorithmsThe American Journal of Medicine 2010;123(8).
  • Dandalides SM, Carey WD, Peters R, et al. Endoscopic small bowel mucosal biopsy: a controlled trial evaluating forceps size and biopsy location in the diagnosis of normal and abnormal mucosal architecture. Gastrointest Endosc 1989;35:197-200.
  • Segal HG, Petras RE. Small intestine, in: S.S. Sternberg (Ed.), Histology for Pathologists, Lippincott-Raven, 1997;495–518.
  • Collin P, Wahab PJ. Murray JA. Intraepithelial lymphocytes and coeliac disease. Best Pract. Res. Clin. Gastroenterol. 2005;19:341–50.
  • Wahab PJ, Meijer JW., Mulder CJ. Histologic followup of people with celiac disease on a gluten-free diet: slow and incomplete recovery, Am. J. Clin. Pathol. 2002;118:459–63.
  • Biagi F, Luinetti O. Campanella J. et al. Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease? J. Clin. Pathol. 2004;57:835–9.
  • Walkera MM, Talley NJ. Clinical value of duodenal biopsies – Beyond the diagnosis of coeliac disease. Pathology – Research and Practice. 2011;207:538– 44
  • Maki M, Holm K, Collin P, Savilahti E. Increase in gamma/delta T cell receptor bearing lymphocytes in normal small bowel mucosa in latent coeliac disease, Gut. 1991;32:1412–4.
  • McGowan KE, Lyon ME, Butzner JD. Celiac disease and IgA deficiency: complications of serological testing approaches encountered in the clinic, Clin. Chem. 2008;54:1203–9.
  • Hopper AD, Hadjivassiliou M, Hurlstone DP, et al. What is the role of serologic testing in celiac disease? A prospective, biopsy-confirmed study with economic analysis, Clin. Gastroenterol. Hepatol. 2008;6:314–
  • Ferguson A, Murray D. Quantitation of intraepitelial lymphocytes in human jejeunm. Gut 1971;12:988.
  • Dib HH, Lu SQ, Wen SF. Prevalence of Giardia lamblia with or without diarrhea in South East South East Asia and the Far East, Parasitol. Res. 2008;103:239–51.
  • Oberhuber G, Kastner N, Stolte M, Giardiasis: a histologic analysis of 567 cases, Scand. J. Gastroenterol. 1997;32:48–51.
  • Yazışma Adresi / Address for Correspondence: Dr. Cansu Abaylı Çukurova University, Faculty of Medicine, Department of Pathology Sarıçam, ADANA Email: cabayli@mynet.com geliş tarihi/received :22.08.2013 kabul tarihi/accepted:24.09.2013
There are 29 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Cansu Abaylı This is me

Figen Doran This is me

Bahri Abaylı This is me

Oğuz Üsküdar This is me

Publication Date July 22, 2014
Published in Issue Year 2014 Volume: 39 Issue: 1

Cite

MLA Abaylı, Cansu et al. “On Yılı Kapsayan Duedonal Biyopsi Kayıtlarının Modifiye Marsh Klasifikasyonu”. Cukurova Medical Journal, vol. 39, no. 1, 2014, pp. 61-69, doi:10.17826/cutf.20314.