Degree of Mucosal Damage and Clinical Presentation of Celiac Disease ? Is There a Connection?

Celiac disease (CD) is an immune-mediated enteropathy induced by gliadin and related prolamins. This study was designed to evaluate the correlation between the degree and uniformity of mucosal damage and forms of CD. The study included a total of 85 children (33 boys and 52 girls, mean age 6.59 years) hospitalized due to CD. Patients were assigned to one of three groups based on their form of disease manifestation: (1) patients with classical form; (2) patients with atypical form; and (3) patients with asymptomatic celiac disease. The diagnosis of CD was based on positive CD specific antibodies, HLA typing and histological analysis of multiple biopsy samples. Histological changes were classified using modified Marsh criteria. Forty one patients had classical form, 32 had atypical form, while 12 patients had asymptomatic form of celiac disease. There was no difference in the degree of damage on small bowel samples between different clinical forms of celiac disease (p=0.079). The frequency of uniformity of enteropathy does not depend on clinical form of the disease (p=0.882). Uniform small bowel mucosal damage was more common in cases of severe degree of mucosal damage (p=0.017). The degree of damage and uniformity of changes in duodenal biopsy specimens did not correlate with mode of presentation, while uniform mucosal damage increased with severity of enteropathy.