Predictive value of "Marsh 1" type histology in subjects with suspected cealic disease. (July 2014)

• Record Type: Journal Article
• Authors: Tortora, Raffaella; Capone, Pietro; Imperatore, Nicola; De Stefano, Giuliano; Gerbino, Nicolò; Leo, Maria; Caporaso, Nicola; Rispo, Antonio
• Is Part Of: Scandinavian journal of gastroenterology. Volume 49:Number 7(2014)
• Page Start: 801
• Page End: 806
• Publication Date: 2014-07
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.3109/00365521.2014.919019
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Introduction.</italic> </bold> The diagnosis of celiac disease (CD) is based on histology in combination with anti-tissue transglutaminase (a-tTG) and anti-endomysial antibodies (EMAs). The increase of intraepithelial lymphocytes defines the Marsh 1 histology that appears not to be specific for CD. Aim: To explore the positive predictive value (PPV) and clinical relevance of Marsh 1 histology in suspected CD. <bold><italic>Methods.</italic></bold> We carried out an observational prospective study including all consecutive subjects with a Marsh 1 histology. All patients were tested for a-tTG and EMAs. Diagnosis of potential CD was defined in the presence of Marsh 1 with positive a-tTG and EMAs. Patients were investigated for symptoms, CD familial aggregation, other diseases, and current medication. <bold><italic>Results.</italic></bold> Sixty-three patients with Marsh 1 were included. Diagnosis of potential CD was made in 23 subjects (36%), so that Marsh 1 histology showed a PPV of 36%. With regard to familial aggregation, patients with potential CD showed a higher frequency of familiarity for CD (60.8% vs. 15.0%; <italic>p</italic> < 0.01). No significant difference was detected between CD and non-CD in terms of intestinal and extra-intestinal symptoms. We also documented the presence of conditions other than CD in the remaining population: 7 patients (17.5%) with immuno-mediated diseases while 5 patients (12.5%) showed <italic>Helicobacter pylori</italic> (HP) infection. About medication, 3 patients (7.5%) were on non-steroidal anti-inflammatory drugs, while another 4 (10%) patients were being treated with other drugs. <bold><italic>Conclusion.</italic></bold> The Marsh 1 type histology is not specific for CD and it can also be associated with immuno-mediated disorders, HP infection, and drugs.</p> </abstract>