title: Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension.
abstract: OBJECTIVE
  To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Marsh criteria.
  
  
  METHODS
  We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence.
  
  
  RESULTS
  Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension.
  
  
  CONCLUSIONS
  This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis of coeliac disease is to be made in the presence of cirrhosis.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, A30, 9500 Euclid Avenue, Cleveland, Ohio 44195, United States. fleminj1@ccf.org
authors.forename: Jamile
authors.initials: J
authors.lastname: Wakim-Fleming
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Zein
authors.forename: Ana
authors.initials: A
authors.lastname: Bennett
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Janice
authors.initials: J
authors.lastname: Santisi
authors.forename: William D
authors.initials: WD
authors.lastname: Carey
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008871:Microvilli / Q000473:pathology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index