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Small Intestine
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Marsh-Oberhuber Classification for Celiac Sprue
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Classify |
Histologic Features |
Correlation |
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0 |
normal mucosa |
celiac disease unlikely. |
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1 |
Increased number of intra-epithelial lymphocytes (>20 per 100 enterocytes), no villous or crypt changes |
Patients on gluten free diet or with minimal exposure, or with dermatitis herpetiformis. Non-specific |
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2 |
Hyperplasia of the crypts of Lieberkuhn |
Spectrum of changes seen in symptomatic celiac disease |
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3 |
Partial or complete villous atrophy |
Spectrum of changes seen in symptomatic celiac disease |
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4 |
Hypoplasia of the small bowel architecture |
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Modified Marsh Classification of histologic findings in celiac disease (Oberhuber)
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Marsh Classification |
0 |
1 |
2 |
3A |
3B |
3C |
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IEL (Jejunum) |
<40 |
>40 |
>40 |
>40 |
>40 |
>40 |
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IEL Duodenum |
<30 |
>30 |
>30 |
>30 |
>30 |
>30 |
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Crypt Hyperplasia |
Normal |
Normal |
Present |
Present |
Present |
Present |
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Villous Atrophy |
Absent |
Absent |
Absent |
Mild |
Marked |
Complete |
* IEL/100 enterocytes, intraepithelial lymphocytes per 100 enterocytes
Marsh M.: Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue')". Gastroenterology 102 (1): 330–54, 1992.
Oberhuber G. et al: "The histopathology of coeliac disease: time for a standardized report scheme for pathologists". Eur J Gastroenterol Hepatol 11 (10): 1185–94, 1999.
Histological Grading of Pouchitis
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