Histopathological Spectrum of Duodenal Biopsies in Seropositive Pediatric Celiac Disease: A Retrospective Study from Yazd, Iran

Maryam  Vajihinejad; Monireh  Sadri; Saadat  Eslami

doi:10.18502/wjpn.v7i2.20446

Maryam Vajihinejad Department of Pathology, School of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Monireh Sadri Department of Pathology, School of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Saadat Eslami Department of Pathology, School of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

DOI: https://doi.org/10.18502/wjpn.v7i2.20446

Keywords: Celiac disease, Anti-tTG IgA, Duodenal, biopsy, Pediatrics, Histopathology

Abstract

Background: Celiac disease (CD) is an immune-mediated enteropathy triggered by gluten, with a global prevalence of approximately 1%. It is strongly associated with HLA-DQ2 and HLA-DQ8 haplotypes. Serological markers, particularly anti-tissue transglutaminase (tTG) immunoglobulin A (IgA), play a pivotal role in screening and diagnosis. This study aimed to evaluate the clinicopathological characteristics of duodenal biopsy specimens from patients with elevated serum tTG IgA levels.

Methods: This retrospective cross-sectional study analyzed 213 pediatric patients (age ≤16 years) with elevated anti-tTG IgA levels who underwent duodenal biopsy at Shahid Sadoughi Hospital, Iran (2016-2020). Demographic, clinical, and histopathological data were collected from medical records. Duodenal biopsies were classified using the Marsh-Oberhuber system. Statistical analysis was performed using SPSS version 22.

Results: The cohort Included 131 females (61.5%) and 82 males (38.5%), with a mean age of 5.9 years. Abdominal pain (58.7%) and failure to thrive (39%) were the most common clinical manifestations. Histopathological analysis revealed Marsh 3 lesions in 77% of cases (3a: 25.8%, 3b: 39.9%, 3c: 11.3%), while mild changes (Marsh 1-2) were observed in 23%. No significant association was found between Marsh classification and gender (P = 0.36).

Conclusion: Elevated anti-tTG IgA levels strongly predict severe mucosal damage in pediatric celiac disease, indicating that serology-based diagnosis could potentially reduce the need for invasive biopsies. Establishing validated antibody thresholds may allow for less invasive diagnostic approaches.