Small intestine in celiac disease

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Author: Mikael Häggström [note 1]

Gross processing

As per Small intestine.

Microscopic evaluation

Intraepithelial lymphocytes, in this case still less than <25 IELs/100 enterocytes.

The main histologic feature of celiac disease is increased intraepithelial lymphocytes (IELs), with or without villous atrophy of the duodenal mucosa.[1] The number of intraepithelial lymphocytes are classified as follows in the duodenum:[2][3]

  • < 25 IELs/100 enterocytes: Negative for intraepithelial lymphocytosis.
  • 25 to 29 IELs/100 enterocytes: borderline
  • > 30 IEL/100 enterocytes: Pathological "lymphocytosis"

Alternative proposed methods is the presence of over 6-12 IELs per 20 enterocytes at the tips of duodenal villi.[3] In the jejunum, the cutoff is at over 40 IELs per 100 enterocytes.[3]

Suggestive but not specific findings for enterocytes are: decreased height, intracytoplasmic vacuolation and reduction or absence of the brush border.[2]

Differential diagnoses

If findings are suggestive of celiac disease, look for at least the following differential diagnoses:

Microscopy report

Example in an unremarkable specimen:

Duodenal mucosa, negative for significant histopathologic changes.
Negative for celiac disease.


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

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  1. Brown, Ian S.; Smith, Jason; Rosty, Christophe (2012). "Gastrointestinal Pathology in Celiac Disease ". American Journal of Clinical Pathology 138 (1): 42–49. doi:10.1309/AJCPE89ZPVJTSPWL. ISSN 0002-9173. 
  2. 2.0 2.1 Erdener Özer. Small intestine & ampulla, Malabsorption, Celiac sprue. Pathology Outlines. Topic Completed: 1 June 2017. Minor changes: 4 April 2020.
  3. 3.0 3.1 3.2 . Celiac Disease. Stanford School of Medicine. Retrieved on 2021-03-11.
  4. Hanni Gulwani. Small intestine & ampulla - Infectious disorders - Giardia lamblia. Pathology Outlines. Topic Completed: 1 August 2012. Minor changes: 3 March 2020

Image sources