title: Predictive value of "Marsh 1" type histology in subjects with suspected cealic disease.
abstract: BACKGROUND
  The diagnosis of celiac disease (CD) is based on histology in combination with anti-tissue transglutaminase (a-tTG) and anti-endomysial antibodies (EMAs). The increase of intraepithelial lymphocytes defines the Marsh 1 histology that appears not to be specific for CD.
  
  
  OBJECTIVE
  To explore the positive predictive value (PPV) and clinical relevance of Marsh 1 histology in suspected CD.
  
  
  METHODS
  We carried out an observational prospective study including all consecutive subjects with a Marsh 1 histology. All patients were tested for a-tTG and EMAs. Diagnosis of potential CD was defined in the presence of Marsh 1 with positive a-tTG and EMAs. Patients were investigated for symptoms, CD familial aggregation, other diseases, and current medication.
  
  
  RESULTS
  Sixty-three patients with Marsh 1 were included. Diagnosis of potential CD was made in 23 subjects (36%), so that Marsh 1 histology showed a PPV of 36%. With regard to familial aggregation, patients with potential CD showed a higher frequency of familiarity for CD (60.8% vs. 15.0%; p < 0.01). No significant difference was detected between CD and non-CD in terms of intestinal and extra-intestinal symptoms. We also documented the presence of conditions other than CD in the remaining population: 7 patients (17.5%) with immuno-mediated diseases while 5 patients (12.5%) showed Helicobacter pylori (HP) infection. About medication, 3 patients (7.5%) were on non-steroidal anti-inflammatory drugs, while another 4 (10%) patients were being treated with other drugs.
  
  
  CONCLUSIONS
  The Marsh 1 type histology is not specific for CD and it can also be associated with immuno-mediated disorders, HP infection, and drugs.
authors: Department of Clinical Medicine and Surgery - University of Naples "Federico II", Gastroenterology , Naples , Italy.
authors: Raffaella
authors: R
authors: Tortora
authors: Pietro
authors: P
authors: Capone
authors: Nicola
authors: N
authors: Imperatore
authors: Giuliano
authors: G
authors: De Stefano
authors: Nicolò
authors: N
authors: Gerbino
authors: Maria
authors: M
authors: Leo
authors: Nicola
authors: N
authors: Caporaso
authors: Antonio
authors: A
authors: Rispo
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000473:pathology*; D003937:Diagnosis, Differential; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: Celiac disease; Marsh; diagnosis; histology