Histopathological Practices of Handling, Processing and Interpretation of Small Intestinal Biopsies for Diagnosis and Management of Celiac Disease

Abstract

Aim: Evaluate the histological findings of celiac disease and to analyze the variations that occurred in biopsies. We aimed to execute the GFD method which helps us in diagnosing and managing celiac disease during follow-up. Methodology: This retrospective study was conducted at the Rawalpindi Medical University hospital from September 2020 to September 2021. Standard bioptic forceps and flexible endoscopes were used to perform upper GIT endoscopy and biopsies. For every patient, we collected 4 biopsy specimens from the duodenum. We cut 3μm thick sections from each block and stained them in a hematoxylin compound. We counted intraepithelial lymphocytes using anti-CD3 immuno histochemical staining. Results: We recruited 69 celiac patients with a total of 2,760 power fields. Out of these 69 patients, 52 were (76%) females and 17 (24%) were males. Patients from the age range 14 to 69 were recruited. The mean age of patients was reported as 39 ± 15 years. By the EF method, we observed improvement in histological patterns of 8 patients, and one remain unchanged. Only 2 cases reported worsened histological outcomes. Conclusion: Interpretation of duodenal biopsies demands different methods of analysis based on the clinical settings to address the presence of atrophy and improvements in CD patients. Keywords: Celiac disease, Marsh-Oberhuber scale, endoscopy