title: Histological evaluation of duodenal biopsies from coeliac patients: the need for different grading criteria during follow-up.
abstract: BACKGROUND
  Coeliac disease is characterised by villous atrophy, which usually normalises after gluten withdrawal. Sometimes the revaluation of duodenal histology is required during follow-up, even if the methodology for comparing duodenal histology before and after introducing a gluten-free diet is not yet established. Our aim was to evaluate a novel criterion to compare duodenal histology in coeliac disease before and after gluten withdrawal.
  
  
  METHODS
  Duodenal biopsies from coeliac patients were retrospectively reviewed to compare duodenal histology at diagnosis and after at least one year on a gluten-free diet. Two different methods were used: the first was represented by the classical Marsh-Oberhuber score, the second compared the areas covered by each Marsh-Oberhuber grade and expressed as percentages, the final grade being calculated from the analysis of ten power fields per duodenal biopsy.
  
  
  RESULTS
  Sixty-nine patients (17 males 52 females, age at diagnosis 36 ± 15 years) who underwent duodenal biopsies, were considered. According to the classical Marsh-Oberhuber scale, 32 patients did not present atrophy during follow-up while 37 showed duodenal atrophy, among whom 26 improved the grade of severity and 11 retained the same one. Of these latter, according to the second method, eight patients were considered improved, two showed a worsened duodenal damage and only one remained unchanged; the evaluation changed in 91 % of cases.
  
  
  CONCLUSIONS
  The proposed semi-quantitative approach (i.e. the second method) for the evaluation of histology at follow-up provides additional information about the progression/regression of the mucosal damage.
authors.affiliation: Center for the Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. lucelli@yahoo.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Elli
authors.affiliation: Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. enea.zini@unimi.it.
authors.forename: Enea
authors.initials: E
authors.lastname: Zini
authors.affiliation: Center for the Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. carolina.tomba@alice.it.|Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20100, Milan, Italy. carolina.tomba@alice.it.
authors.forename: Carolina
authors.initials: C
authors.lastname: Tomba
authors.affiliation: Center for the Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. mariateresa.bardella@yahoo.com.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Bardella
authors.affiliation: Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. silvano.bosari@unimi.it.|Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20100, Milan, Italy. silvano.bosari@unimi.it.
authors.forename: Silvano
authors.initials: S
authors.lastname: Bosari
authors.affiliation: Center for the Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. dario.conte@unimi.it.|Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono 7, 20100, Milan, Italy. dario.conte@unimi.it.
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.affiliation: Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. letterio.runza@policlinico.mi.it.
authors.forename: Letterio
authors.initials: L
authors.lastname: Runza
authors.affiliation: Center for the Prevention and Diagnosis of Coeliac Disease, Gastroenterology and Endoscopy Unit - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. leda.roncoroni@tiscali.it.
authors.forename: Leda
authors.initials: L
authors.lastname: Roncoroni
authors.affiliation: Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20100, Milan, Italy. stefano.ferrero@unimi.it.|Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via Festa del Perdono 7, 20100, Milan, Italy. stefano.ferrero@unimi.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D002446:Celiac Disease / Q000473:pathology*; D018450:Disease Progression; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult