Morphologic features of celiac disease

What are the morphologic features of celiac disease? 

The normal duodenal mucosa has numerous fingerlike projections, or villi, whereas in celiac disease the normal villous architecture is lost (blunted villi and crypt hyperplasia) and intraepithelial lymphocytes (IELs) are increased. Increased IELs are seen more toward the tips of the villi. These are T lymphocytes that can be highlighted by CD3 immunohistochemical stain.

The Marsh criteria represent a morphologic classification that defines the many histologic features of this entity. The modified classification (Marsh-Oberhuber) subdivides Marsh 3 into A, B, and C as partial, subtotal, or total villous atrophy, respectively. Corazza classification simplifies it further into Grade A, B1, and B2, representing Marsh type 1, 3a, and 3c, respectively. The comparison and summary of histologic classifications is depicted in the below table.

Histologic Classifications of Celiac Disease

Marsh Modified (Oberhuber)Histologic CriteriaCorazza
IEL *Crypt HyperplasiaVillous Atrophy
Type 0NoNoNoNone
Type 1YesNoNoGrade A
Type 2YesYesNo
Type 3aYesYesYes (partial)Grade B1
Type 3bYesYesYes (subtotal)
Type 3cYesYesYes (total)Grade B2

IEL, Intraepithelial lymphocytes.

* > 40 IEL per 100 enterocytes for Marsh modified (Oberhuber); > 25 IEL per 100 enterocytes for Corazza.

Treated celiac disease may show normal villous architecture but the IELs are still increased.


Adapted from Rubio-Tapia A, et al. ACG clinical guidelines: Diagnosis and management of celiac disease. Am J Gastroenterol 2013;108(5):656–676.


Sign up to receive the trending updates and tons of Health Tips

Join SeekhealthZ and never miss the latest health information

Scroll to Top