title: Comparative study of histopathological Marsh grading with clinical and serological parameters in celiac iceberg of north India.
abstract: BACKGROUND
  Celiac disease is an autoimmune disorder caused by the ingestion of wheat gluten and related proteins in genetically susceptible individuals. It is characterized by anti-tissue transglutaminase (anti-tTG) antibodies. Duodenal biopsy is the gold standard for diagnosis. Correlation of clinical, serologic, and histological features is essential for a definitive diagnosis. The ratio of diagnosed versus undiagnosed cases is quite high.
  
  
  OBJECTIVE
  This study aimed to correlate the degree of mucosal damage with anti-tTG levels, mean baseline hemoglobin and endoscopic findings.
  
  
  METHODS
  Two hundred twenty six adults suspected to have celiac disease were studied. Marsh grades were compared with anti-tTG levels, hemoglobin, endoscopy, and clinical presentations.
  
  
  METHODS
  Esophagogastroduodenoscopy, serum levels of anti-tTG, complete hematologic work-up, and duodenal biopsy were performed in all 226 cases (including three siblings of confirmed patients) with well-defined symptom groups. Histopathological grading was done as per modified Marsh system. Correlation of all the parameters was performed with Marsh grades.
  
  
  METHODS
  Performed on SPSS version 15.0. Tests applied include one way ANOVA, Chi-square test, repeated measure analysis, and Bonferroni's method for comparison. Results were considered significant when P<0.05.
  
  
  CONCLUSIONS
  Anti-tTG levels, mean baseline hemoglobin, and endoscopic findings were found to correlate with increasing severity of mucosal damage with P<0.001 for all. Anti-tTG levels of grades 1+2 and those of grade 3a were significantly different from levels of grades 3b and 3c+4 with P<0.001 for each. Varied clinical presentations of celiac disease were seen in the adult wheat eaters of North India.
authors.affiliation: Department of Pathology, Army College of Medical Sciences, Delhi Cantt, India. shivani_kalhan@yahoo.co.in
authors.forename: Shivani
authors.initials: S
authors.lastname: Kalhan
authors.forename: Preeti
authors.initials: P
authors.lastname: Joseph
authors.forename: Sonia
authors.initials: S
authors.lastname: Sharma
authors.forename: Suparna
authors.initials: S
authors.lastname: Dubey
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dudani
authors.forename: Monika
authors.initials: M
authors.lastname: Dixit
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002446:Celiac Disease / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D016145:Endoscopy, Digestive System; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007194:India; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D011503:Transglutaminases / Q000276:immunology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D011503:Transglutaminases