Histological spectrum of celiac disease in 63 newly diagnosed patients at a tertiary care hospital.

INTRODUCTION: Celiac disease (CD) is characterized by malabsorption, altered small bowel histology induced by dietary exposure to gluten in genetically predisposed individuals. In spite of the tremendous increase in our knowledge regarding the clinical, pathological and genetic aspects of CD, the histological examination still remains the gold standard for its diagnosis. Recently, Corazza and Villanacci introduced a classification that reduces the number of categories and the interobsrver variation. This study was undertaken to evaluate the various morphological spectrums of duodenal pathology in CD according to the new classification system proposed by Corazza and Villanacci. MATERIALS AND METHODS: The present study comprises of 63 patients who tested positive for anti TTG antibodies at Sri Guru Ramdass Institute of Medical Sciences and research, Amritsar, Punjab. Anti TTG levels were documented at initial presentation to the hospital. The detailed history of the patient i.e. age, sex and duration of symptoms and other investigations performed, were recorded. OBSERVATIONS & RESULTS: The age group ranged from 07-64 years. The mean age was 29.4 years. There were 39 females and 24 males in the study group with a M:F ratio of 1:1.6. The mean serum anti TTG level at presentation was 142.4 U/ml, ranging from 14 to 456. Anti TTG levels of > 100 were found in 27 patients. There was significant positive correlation between anti TTG levels and histological changes as per Corazza staging. The histology was classified according to Corazza staging into Type A, B1 and B2. 3 patients were classified into type A, 25 into type B1 and 35 into type B2. CONCLUSION: Although histopathology is considered as the gold standard in its diagnosis, a single test cannot diagnose this entity and thus it requires a combination of clinical features, serology and histopathological features to give a presumptive diagnosis of CD. The final diagnosis rests on the improvement of the symptoms/serological values/biopsy findings after gluten free diet.