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Marsh Stage of Celiac Disease


Updated October 07, 2009

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Marsh Score for Celiac Disease, Stage 3
Marsh Stage of Celiac Disease

This is a photomicrograph of a biopsy sample of the lining of a small intestine that's been damaged by gluten.

© 2009 Ludvigsson et al.
When the diagnosis is celiac disease Marsh score stage 3, the changes of Stage 2 are present (increased lymphocytes and larger-than-normal crypts), and the villi are shrinking and flattening (atrophy). There are three levels of Stage 3:
--Partial villous atrophy (Stage 3a), or
--Subtotal villous atrophy (Stage 3b), or
--Total villous atrophy (Stage 3c).


This photomicrograph is from Figure 1c 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.


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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