Morphometric evaluation of duodenal biopsies in celiac disease.
OBJECTIVE
The Marsh classification is a semiquantitative method for the diagnosis and monitoring of changes in duodenal biopsies in celiac disease. We have explored the possibility that quantitative changes in villous area and crypt length (morphometry) may provide better information on changes in duodenal morphology, particularly after the introduction of a gluten-free diet.


METHODS
We measured villous height, apical and basal villous widths, and crypt length in 57 adults with celiac disease and 83 control subjects. Villous area was calculated as a trapezoid approximation. Serial changes in villous area and crypt length were determined at regular intervals for up to 4 years after the introduction of a gluten-free diet. Morphometric changes were also correlated with Marsh grade, self-reported adherence to a gluten-free diet, and changes in celiac serology.


RESULTS
The gluten-free diet resulted in a progressive increase in villous area and a progressive decrease in crypt length. Morphometric improvement reached a plateau after 6-12 months with mean villous area attaining a value approximately half that of control subjects. Morphometric data were more sensitive than Marsh grade. Improvement in morphometric indices was significantly associated with the disappearance of anti-endomysial IgA antibody but not with dietary compliance.


CONCLUSIONS
Morphometry is a sensitive way to document changes in duodenal biopsies in celiac disease. In adults treated with a gluten-free diet, it is uncommon for villous area to return to values observed in control subjects, but morphometric improvement is associated with the disappearance of anti-endomysial IgA antibody.
Cummins
Adrian G
AG
Digestive Disease Research Centre, Basil Hetzel Institute for Medical Research, Adelaide, South Australia, Australia. adrian.cummins@health.sa.gov.au
Alexander
Basile G
BG
Chung
Adrian
A
Teo
Edward
E
Woenig
Josh A
JA
Field
John B J
JB
Thompson
Fiona M
FM
Roberts-Thomson
Ian C
IC
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D016022:Case-Control Studies; D002446:Celiac Disease / Q000178:diet therapy* / Q000473:pathology* / Q000503:physiopathology; D055050:Diet, Gluten-Free; D004384:Duodenoscopy / Q000379:methods; D004386:Duodenum / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D042282:Microdissection; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010349:Patient Compliance; D012016:Reference Values; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult