title: An update on celiac disease histopathology and the road ahead.
abstract: BACKGROUND
  Celiac disease (CD) is a common immune-mediated disorder that occurs in genetically predisposed individuals (carriers of HLA-DQ2 and DQ8 haplotypes) on consumption of wheat (gluten). It is characterized by inflammation of the small-intestinal mucosa and myriad gastrointestinal and systemic manifestations. Celiac disease is common in the general population (prevalence, 0.5%-1%). Currently, small-bowel biopsy is considered the gold standard for diagnosing CD. However, the role of serologic testing in the diagnosis of CD has evolved, from being a supportive test to supplanting intestinal biopsies in certain patient populations.
  
  
  OBJECTIVE
  To summarize key aspects of histopathologic assessment, discuss the benefit of standardized pathology reports, impact of the site and number of small-bowel biopsy samples on diagnosis, and recommendations regarding serologic testing.
  
  
  METHODS
  Literature review of publications on CD and experience with histopathologic review of biopsies at the Department of Pathology and Cell Biology, Columbia University Medical Center, New York-Presbyterian Hospital, New York.
  
  
  CONCLUSIONS
  Intraepithelial lymphocytosis in the context of villous atrophy is considered a characteristic histologic finding of CD; however, it is a rather nonspecific finding. A growing list of publications has also indicated that the detection of intraepithelial lymphocytosis in the absence of villous atrophy has rather low specificity for CD. Therefore, communication between pathologists and gastroenterologists is paramount, as is knowledge regarding the pertinent clinical and laboratory data, in distinguishing between CD and other disorders with similar histopathologic and clinical manifestations.
authors: Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA. fb2266@columbia.edu
authors: Fei
authors: F
authors: Bao
authors: Peter H R
authors: PH
authors: Green
authors: Govind
authors: G
authors: Bhagat
mesh_terms: D001284:Atrophy / Q000276:immunology / Q000473:pathology; D002446:Celiac Disease / Q000235:genetics / Q000276:immunology / Q000473:pathology*; D020022:Genetic Predisposition to Disease; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000473:pathology; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology*; D007421:Intestine, Small / Q000276:immunology / Q000473:pathology*