{"id":5609,"date":"2013-08-05T16:06:39","date_gmt":"2013-08-05T16:06:39","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/celiac-disease-oberhuber\/"},"modified":"2025-05-13T20:27:56","modified_gmt":"2025-05-13T20:27:56","slug":"celiac-disease-oberhuber","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/celiac-disease-oberhuber\/","title":{"rendered":"Modified Marsh Classification of Histologic Findings in Celiac Disease (Oberhuber)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p><span style=\"line-height: 1.3em;\">Celiac disease is a systemic immune-mediated disorder triggered by dietary gluten in genetically susceptible persons. Gluten is a protein complex found in wheat, rye, and barley. Celiac disease is characterized by a broad range of clinical presentations, a specific serum autoantibody response, and variable damage to the small intestinal mucosa. <\/span><br \/>\n<!--more--><br \/>\n<strong style=\"line-height: 1.3em;\">Modified Marsh Classification of histologic findings in celiac disease (Oberhuber)<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr style=\"text-align: center;\">\n<td style=\"width: 11.0303%;\" valign=\"top\"><strong>Marsh Type<\/strong><\/td>\n<td style=\"width: 23.0303%;\" valign=\"top\"><strong>IEL \/ 100 enterocytes \u2013 jejunum<\/strong><\/td>\n<td style=\"width: 25.9394%;\" valign=\"top\"><strong>IEL \/ 100 enterocytes &#8211; duodenum<\/strong><\/td>\n<td style=\"width: 20.6061%;\" valign=\"top\"><strong>Crypt hyperplasia<\/strong><\/td>\n<td style=\"width: 19.2727%;\" valign=\"top\"><strong>Villi<\/strong><\/td>\n<\/tr>\n<tr style=\"text-align: center;\">\n<td style=\"width: 11.0303%;\" valign=\"top\"><strong>0<\/strong><\/td>\n<td style=\"width: 23.0303%;\" valign=\"top\">&lt;40<\/td>\n<td style=\"width: 25.9394%;\" valign=\"top\">&lt;30<\/td>\n<td style=\"width: 20.6061%;\" valign=\"top\">Normal<\/td>\n<td style=\"width: 19.2727%;\" valign=\"top\">Normal<\/td>\n<\/tr>\n<tr style=\"text-align: center;\">\n<td style=\"width: 11.0303%;\" valign=\"top\"><strong>1<\/strong><\/td>\n<td style=\"width: 23.0303%;\" valign=\"top\">&gt;40<\/td>\n<td style=\"width: 25.9394%;\" valign=\"top\">&gt;30<\/td>\n<td style=\"width: 20.6061%;\" valign=\"top\">Normal<\/td>\n<td style=\"width: 19.2727%;\" valign=\"top\">Normal<\/td>\n<\/tr>\n<tr style=\"text-align: center;\">\n<td style=\"width: 11.0303%;\" valign=\"top\"><strong>2<\/strong><\/td>\n<td style=\"width: 23.0303%;\" valign=\"top\">&gt;40<\/td>\n<td style=\"width: 25.9394%;\" valign=\"top\">&gt;30<\/td>\n<td style=\"width: 20.6061%;\" valign=\"top\">Increased<\/td>\n<td style=\"width: 19.2727%;\" valign=\"top\">Normal<\/td>\n<\/tr>\n<tr style=\"text-align: center;\">\n<td style=\"width: 11.0303%;\" valign=\"top\"><strong>3a<\/strong><\/td>\n<td style=\"width: 23.0303%;\" valign=\"top\">&gt;40<\/td>\n<td style=\"width: 25.9394%;\" valign=\"top\">&gt;30<\/td>\n<td style=\"width: 20.6061%;\" valign=\"top\">Increased<\/td>\n<td style=\"width: 19.2727%;\" valign=\"top\">Mild atrophy<\/td>\n<\/tr>\n<tr style=\"text-align: center;\">\n<td style=\"width: 11.0303%;\" valign=\"top\"><strong>3b<\/strong><\/td>\n<td style=\"width: 23.0303%;\" valign=\"top\">&gt;40<\/td>\n<td style=\"width: 25.9394%;\" valign=\"top\">&gt;30<\/td>\n<td style=\"width: 20.6061%;\" valign=\"top\">Increased<\/td>\n<td style=\"width: 19.2727%;\" valign=\"top\">Marked atrophy<\/td>\n<\/tr>\n<tr style=\"text-align: center;\">\n<td style=\"width: 11.0303%;\" valign=\"top\"><strong>3c<\/strong><\/td>\n<td style=\"width: 23.0303%;\" valign=\"top\">&gt;40<\/td>\n<td style=\"width: 25.9394%;\" valign=\"top\">&gt;30<\/td>\n<td style=\"width: 20.6061%;\" valign=\"top\">Increased<\/td>\n<td style=\"width: 19.2727%;\" valign=\"top\">Complete atrophy<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span style=\"line-height: 1.3em;\">IEL\/100 enterocytes, intraepithelial lymphocytes per 100 enterocytes<\/span><\/p>\n<ul>\n<li>Type 0: Normal; celiac disease highly unlikely.<\/li>\n<li>Type 1: Seen in patients on gluten free diet (suggesting minimal amounts of gluten or gliadin are being ingested); patients with dermatitis herpetiformis; family members of celiac disease patients, not specific, may be seen in infections.<\/li>\n<li>Type 2: Very rare, seen occasionally in dermatitis herpetiformis.<\/li>\n<li>Type 3: Spectrum of changes seen in symptomatic celiac disease.<\/li>\n<\/ul>\n<p><strong>Simplified system (Corazza, Roberts, Ensari)<\/strong><\/p>\n<ul>\n<li>Grade A\/Type 1: increased intraepithelial lymphocytes but no villous atrophy\n<ul>\n<li>Seen in patients on gluten-free diet (suggesting minimal amounts of gluten or gliadin are being ingested); patients with dermatitis herpetiformis; family members of celiac disease patients, not specific, may be seen in infections<\/li>\n<\/ul>\n<\/li>\n<li>Grade B1\/Type 2: villi still present but shortened\n<ul>\n<li>Spectrum of changes seen in symptomatic celiac disease<\/li>\n<\/ul>\n<\/li>\n<li>Grade B2\/Type 3: complete villous atrophy\n<ul>\n<li>Spectrum of changes seen in symptomatic celiac disease<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Bao F, Bhagat G. Histopathology of celiac disease. Gastrointest Endosc Clin N Am. 2012 Oct;22(4):679-94.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23083986\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Oberhuber G. Histopathology of celiac disease. Biomed Pharmacother. 2000 Aug;54(7):368-72.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/10989975\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Dickson BC, Streutker CJ, Chetty R. Coeliac disease: an update for pathologists. J Clin Pathol. 2006 Oct;59(10):1008-16.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17021129\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999 Oct;11(10):1185-94.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/10524652\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Corazza GR, Villanacci V. Coeliac disease. J Clin Pathol. 2005 Jun;58(6):573-4.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15917404\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Aug 30, 2013.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[53],"tags":[1891,2012,166,167,51,50,276,277,796,2011,2010,2009,669,2013],"class_list":["post-5609","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-celiac","tag-celiaca","tag-clasificacion","tag-classification","tag-disease","tag-enfermedad","tag-findings","tag-hallazgos","tag-histologic","tag-histologicos","tag-marsh","tag-modificado","tag-modified","tag-oberhuber"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5609","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=5609"}],"version-history":[{"count":3,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5609\/revisions"}],"predecessor-version":[{"id":8852,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5609\/revisions\/8852"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=5609"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=5609"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=5609"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}