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.
