Comparison of Marsh classification with anti-tissue transglutaminase levels and nutrition parameters in celiac patients undergoing endoscopic biopsy

Objective: Celiac disease is an autoimmune enteropathy triggered by gluten intake, leading not only to histopathological changes in the intestinal mucosa but also to systemic nutritional deficiencies. This study aimed to investigate the relationship between Marsh classification findings obtained from endoscopic biopsies, serum anti-tissue transglutaminase (anti-tTG) antibody levels, and key nutritional parameters (hemoglobin, albumin, ferritin, etc.) in adult patients diagnosed with celiac disease. Additionally, the study evaluated whether disease severity could be predicted based on serological and nutritional indicators. Methods: A total of 130 adult patients who underwent endoscopic biopsy and were confirmed to have celiac disease were retrospectively analyzed. Serum anti-tTG IgA and anti-tTG IgG levels were measured. Hemoglobin, albumin, ferritin, folat, vitamin B12, calcium levels were also recorded as nutritional markers. Biopsy samples were classified according to Marsh classification, ranging from Marsh 1 to Marsh 4. Serum anti-tTG levels and nutritional parameters were compared across different Marsh stages using statistical analysis. Results: The majority of patients exhibited Marsh 3a, 3b, or 3c histopathological changes. Serum anti-tTG levels significantly increased with the progression of Marsh stages, reaching the highest values in the Marsh 3c group (p<0.001). A significant negative correlation was observed between Marsh stage and both hemoglobin and albumin levels (p<0.05). Anemia and hypoproteinemia were notably prevalent in patients classified as Marsh 3b and 3c. Ferritin levels tended to decrease as the Marsh stage advanced. Conclusion: In celiac disease, histopathological staging through Marsh classification reflects not only the degree of mucosal damage but also correlates with serological activity and nutritional status. High anti-tTG levels combined with low hemoglobin and albumin concentrations may indicate severe mucosal injury and malabsorption. Therefore, a comprehensive evaluation incorporating Marsh classification, serological markers, and nutritional parameters is essential in the diagnosis and follow-up of celiac disease.Keywords: Celiac disease, Marsh classification, anti-tissue transglutaminase, nutritional parameters, endoscopic biopsy.