"Give us this day our daily bread"--evolving concepts in celiac sprue.
BACKGROUND
Celiac sprue affects genetically susceptible individuals, who develop small intestinal injury and malabsorption following dietary exposure to gluten. The histologic features are nonspecific but characteristic.


OBJECTIVE
To outline the histologic features of celiac sprue and the necessary clinical context to permit a diagnosis of celiac sprue, to assist the pathologist to identify artifactual biopsy changes that may mimic sprue, to define the differential diagnosis for conditions with a similar histology, and to review historic investigations of this disease.


METHODS
Sources include the historic experiments and clinical work of members of the Gastroenterology Division of the Department of Medicine and experiences with gastrointestinal pathology consultation material at the University of Washington, Seattle, with reference to selected peer-reviewed articles.


CONCLUSIONS
Confirmation of a diagnosis of celiac sprue is 2-fold: first, biopsy evidence of a characteristic, but nonspecific, pattern of injury including villous blunting or flattening, surface enterocyte damage, and increased intraepithelial lymphocytes; and second, dramatic clinical response to a gluten-free diet. Complete gluten removal from the diet is effective treatment for patients with symptoms of malabsorption; however, lifelong adherence to the diet is expensive, socially limiting, and nearly impossible on a contemporary diet with manufactured foodstuffs. Therefore, pathologists should avoid overdiagnosis of celiac disease based on minimal, nonspecific histologic changes.
Upton
Melissa P
MP
Department of Pathology, University of Washington Medical Center, Seattle, WA 98195-6100, USA. mupton@u.washington.edu
D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy* / Q000473:pathology*; D004035:Diet Therapy; D005983:Glutens / Q000009:adverse effects; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007413:Intestinal Mucosa / Q000473:pathology*; D011503:Transglutaminases / Q000276:immunology
D007070:Immunoglobulin A; D005983:Glutens; D011503:Transglutaminases