Evaluation of our gluten-sensitive enteropathy patients according to the Marsh classification

Evaluation of our celiac disease (Gluten sensitive enteropaty) patients according to the Marsh classification Dr. NurARSLAN Celiac disease (gluten sensitive enteropathy) is an inflammatory disease of variable severity which results from sensitivity to ingested dietary gluten in genetically susceptible people. The typical clinical picture of celiac disease with chronic diarrhea, abdominal distention and failure to thrive is encountered during the first two years of life. Histological examination of biopsies from the small bowel is the gold standard for the diagnosis of celiac disease. The presence of circulating antibodies and their dissapearance on a gluten-free diet supports the diagnosis. It is suggested that the wide spectrum of clinical findings is related to the severity of intestinal damage. The aim of this study is to determine the frequency of different histopathological celiac types and their association with clinical and laboratory findings. Twenty six patients with celiac disease were included in the study. Weight, height and weight for height of patients were measured on admission. Routine hematologic and biochemical analysis, immunoglobulin A levels, D-xylose tests were performed and, IgA anti-endomysium and antigliadin antibodies (IgG and IgA) were analyzed. Intestinal biopsies were performed on all patients. Mucosal lesions were classified according to the Marsh classification. Villous area, crypt height and mitotic count were measured morphometrically for all biopsy samples. The mean age of the patients was 6.41 ±5.0 years on admission (range 15 months-17years). Fourteen patients (53.7%) were admitted for diarrhea, 11 (42.5%) for short stature and one (3.8%) for pallor and fatigue. Anemia, elevated aminotransferase levels and hypoalbuminemia were detected in 19 (73.0%), 7 (26.9%) and 7 (26.9%) patients, respectively. Histopathological findings of intestinal biopsies were determined as Marsh 1 and Marsh 3 for 5 (19.2%) and 21 (80.8%) patients, respectively. Seven patients were classified as Marsh 3a, 8 as Marsh 3b, and 6 as Marsh 3c. There were no patients with, histopathological findings in Marsh class 0, 2 and 4. Antigliadin IgA, IgG and antiendomysium IgA antibodies were found positive in 17 (70.8%), 20 (83.3%) and 15 (62.5%) patients, respectively. Antiendomysiumntibodies were positive in 75% of patients with type 1 lesions, 60% in patients with pe 3 lesions (p=0.513), and 100.0% in patients with type 3c lesions, ditiendomysium antibody positivity did not differ between patients younger than or Ider than 2 years of age (50.0% and 66.7%, respectively; p=0.634). Age, anthropometric measurements, D-xylose, alanin aminotransferase and Ibumin levels on admission were not significantly different for patients with intiendomysium antibody positive or negative. Moreover, there was no significant ifference in mean villous area, crypt height and mitotic count between intestinal lamples of these two groups on admission. A reduction of the villous area was seen as the histopathological stage ncreased (p=0.000, r= -0.973). Similarly, mitotic count and cript height increased as he histopathological stage increased (p=0.000, r=0.907 and p=0.000, r=0.904, espectively). Chief complaints of patients in the Marsh 1 group were diarrhea in 3 patients md short stature in 2 patients. In patients with Marsh 3a, 3 had diarrhea and 3 had short stature on admission. In group Marsh 3b 2 had diarrhea and 6 short stature. All )atients in the Marsh 3c group had diarrhea on admission. There was no significant difference in hemoglobin, aminotransferase, albumin and D-xylose levels between different histopathological groups. In conclusion, celiac disease presents with typical symptoms in most pediatric patients. On the other hand, it should be kept in mind that patients can also present with atypical symptoms in which case a diagnosis can be established by using sensitive tests. In suspected cases intestinal biopsy should be performed even if antiendomysium antibodies are negative. Although partial or total villous atrophy are detected in the intestinal biopsy of most of the patients, patients with Marsh type 1 lesions are seen less frequently. No correlation was detected between severity of abnormal laboratory test results, initial complaints and histopathological classification. Key words: Gluten sensitive enteropathy, Marsh classification, child 4