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Marsh Stage of Celiac Disease

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Updated October 07, 2009

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Marsh Score for Celiac Disease, Stages 1-2
Marsh Stage of Celiac Disease

This is a photomicrograph of a biopsy sample of the lining of small intestine with evidence of inflammation.

© 2009 Ludvigsson et al
In celiac disease with a Marsh score of Stage 1, the cells on the surface of the intestinal lining (the epithelial cells) have more lymphocytes (white blood cells) among them than normal.

This finding is not specific to celiac disease, however. Increased epithelial lymphocytes can also occur in other conditions, including inflammatory bowel disease, Sjogren’s syndrome, Helicobacter pylori gastritis, use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, and other food intolerances.

In Marsh score Stage 2, the changes of Stage 1 are present (increased lymphocytes), and the crypts are larger than normal.

Acknowledgement

This photomicrograph is from Figure 1b of Ludvigsson et al. BMC Gastroenterology 2009 9:19. doi:10.1186/1471-230X-9-19. The photomicrographs were obtained from Prof. Åke Öst, earlier chairman of the Swedish National Steering Group for Small Intestinal Pathology).

Sources

Ludvigsson JF, Brandt L, Montgomery SM, Granath F, Ekbom A. Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers. BMC Gastroenterol. 2009;9:19.

Snyder CL, Young DO, Green PHR, Taylor AK. GeneReviews: Celiac Disease. 2009

Hill ID, Dirks MH, Liptak GS, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society fo Pediatric Gastroenterology, Hepatology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition 2005;40:1-19.

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