Flattening of the normal 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.
Before 1960 gluten withdrawal followed by improvement and subsequent worsening upon rechallenge was the diagnostic criteria.
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.
Celiac disease biopsy: What does the pathologist look for under the microscope?
The small intestine normally has finger like projections called villi that give it a large surface area or contact area for absorption.
Lining the outside surface of each villous are intestinal cells or enterocytes that secrete mucus and absorb fluids, nutrients, minerals like iron, and vitamins like B12.
At the base of the villi are crypts or circular like collections of intestinal cells.
However, intestinal injury can result in blunting, shortening (partial villous atrophy) or complete loss of the villi and flattening (villous atrophy) of the intestinal surface.
The result is lack of absorption of nutrients and water resulting in weight loss, malnutrition, and diarrhea.
However, an increased number of IEL's (intra-epitheliel lymphocytes) in the setting of a positive specific blood test for celiac, symptoms and especially if supported by presence of DQ2 and/or DQ8 gene pattern, is highly suggestive of celiac disease.
Also, some people with milder forms of celiac have no blood tests abnormal but have classic biopsy findings of celiac and are termed seronegative (blood test negative) celiacs.
However, recent studies have shown that the biopsy can be normal in some people with celiac.
However, more importantly is the recent recognition that normal appearing biopsies may not be normal.
Special stains, that include immune labeling of lymphocytes, have also confirmed increased numbers of certain types of specific lymphocytes in the villi of intestinal biopsies of people confirmed to have celiac.
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.
ibuprofen etc), autoimmune enteropathy, Helicobacter pylori infection (the stomach ulcer bacteria), AIDs, common variable immunodeficiency, and lymphoma of the intestine are all possible causes of small intestine changes that may mimic celiac.
The likelihood is further increased if you carry one or both of the two major genes associated with celiac disease, DQ2 and/or DQ8.
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The First Year: Celiac Disease and Living Gluten-Free: An Essential Guide for the Newly Diagnosed
celiac disease
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