Histopathological Assessment of Celiac Disease

Celiac Disease (CD) is an immune-mediated inflammatory disorder of the small intestine, affecting genetically susceptible individuals when exposed to gluten. Small intestinal biopsy interpretation has been the gold standard for the diagnosis of celiac disease (CD) for over 50 years. Despite today’s availability of sensitive and specific serological diagnostic tests, the histopathological features from mucosal biopsy continue to play a key role in the diagnostic approach when CD is suspected. Such a diagnostic approach requires a multidisciplinary team to optimize both tissue sampling and diagnostic interpretation, as long as interaction between the pathologist and the gastroenterologist is expected. The correct methodological approach, the morphological characteristics of CD, its complications and differential diagnosis have been discussed with attention also to a new entity as Non Celiac Gluten Sensitivity (NCGS). Moreover the use of anti-CD3 and anti-CD8 stains are recommended in patients not responding to the gluten -free diet (GFD), in order to confirm a diagnosis of Refractory Celiac Disease (RCD).