title: Classification chaos in coeliac disease: Does it really matter?
abstract: The spectrum of mucosal pathology in coeliac disease (CD), initially defined by Marsh in 1992 has been subjected to several modifications in the following years by Oberhuber, then by Corazza and Villanaci, and finally by Ensari. The present study, aimed to end the ongoing confusion regarding the classification of mucosal pathology in CD by applying all the classifications proposed so far on a large series of cases. A total of 270 duodenal biopsies taken from the distal duodenum of patients with a diagnosis of CD were included in the study. All biopsies were classified according to Marsh, Oberhuber, Corazza Villanaci, and Ensari classification schemes. For statistical analyses cases were divided into three groups: Group 1 included type 1 lesions in Marsh, Ensari, and Oberhuber and grade A in Corazza Villanaci classifications. Group 2 comprised of type 2 lesions in Marsh and Ensari classifications together with type2, type 3a and 3b lesions in Oberhuber classification and grade B1 lesions in Corazza Villanaci classification. Group 3 included type 3 lesions in Marsh and Ensari classifications, and type 3c lesions in Oberhuber, and grade B2 lesions in Corazza Villanaci classifications. The kappa value was 1.00 (excellent) for group 1, 0.53 (fair) for group 2 and 0.78 (excellent) for group 3 (p<0.0001). These results suggest that any of the above classification system would serve similar purposes in the diagnosis of CD. Therefore, it is advisable that the pathologist should use the simplest reliable scheme.
authors.affiliation: Departments of Pathology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: Hilal
authors.initials: H
authors.lastname: Özakıncı
authors.affiliation: Departments of Pathology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: Ayça
authors.initials: A
authors.lastname: Kırmızı
authors.affiliation: Departments of Pathology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Savaş
authors.affiliation: Departments of Gastroenterology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: Çağdaş
authors.initials: Ç
authors.lastname: Kalkan
authors.affiliation: Departments of Gastroenterology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: İrfan
authors.initials: İ
authors.lastname: Soykan
authors.affiliation: Departments of Gastroenterology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: Hülya
authors.initials: H
authors.lastname: Çetinkaya
authors.affiliation: Departments of Paediatric Gastroenterology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: Zarife
authors.initials: Z
authors.lastname: Kuloğlu
authors.affiliation: Departments of Paediatric Gastroenterology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: Aydan
authors.initials: A
authors.lastname: Kansu
authors.affiliation: Departments of Paediatric Gastroenterology, Gazi University Medical School, 06560, Yenimahalle, Ankara, Turkey.
authors.forename: Ödül Eğritaş
authors.initials: ÖE
authors.lastname: Gürkan
authors.affiliation: Departments of Paediatric Gastroenterology, Gazi University Medical School, 06560, Yenimahalle, Ankara, Turkey.
authors.forename: Buket
authors.initials: B
authors.lastname: Dalgıç
authors.affiliation: Departments of Biostatistics, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Şentürk
authors.affiliation: Departments of Pathology, Ankara University Medical School, 06100, Sıhhıye, Ankara, Turkey. Electronic address: ensariarzu@gmail.com.
authors.forename: Arzu
authors.initials: A
authors.lastname: Ensari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002446:Celiac Disease / Q000145:classification* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000473:pathology*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Classification; Coeliac disease; Mucosal pathology