Statement on best practices in the use of pathology as a diagnostic tool for celiac disease: A guide for clinicians and pathologists

Marie E. Robert, Sheila E. Crowe, Lawrence Burgart, Rhonda K. Yantiss, Benjamin Lebwohl, Joel K. Greenson, Stefano Guandalini, Joseph A. Murray

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Small intestinal biopsy interpretation has been the cornerstone for the diagnosis of celiac disease for over 50 years. Despite the existence of sensitive and specific serological tests, duodenal mucosal biopsies continue to be obtained in the vast majority of patients in whom a diagnosis of celiac disease is being considered. The accurate evaluation of these biopsies requires coordination and information sharing between the gastroenterologist, laboratory, and pathologist in order to optimize tissue sampling, preparation and interpretation. This document, a collaboration between the Rodger C. Haggitt Gastrointestinal Pathology Society and the North American Association for the Study of Celiac Disease, is intended to provide clinicians and pathologists with a summary of best practices in the use of endoscopy and biopsy for patients with suspected celiac disease. The authors present a comprehensive and critical appraisal of the literature with respect to the topics of endoscopic findings, best methods for the obtaining biopsies, completing the pathology form and pathologic assessment, including evaluating intraepithelial lymphocytes and villous architecture. A discussion of conditions with overlapping pathologic findings in duodenal mucosal biopsies is presented. In order to provide additional guidance for challenging situations, the authors include an appendix containing practical suggestions. This review may be utilized in interdisciplinary discussions to optimize care for patients with possible celiac disease.

Original languageEnglish (US)
Pages (from-to)e44-e58
JournalAmerican Journal of Surgical Pathology
Issue number9
StatePublished - Sep 1 2018


  • Celiac disease
  • Drug injury
  • Duodenal biopsy
  • Intraepithelial lymphocytes
  • Tissue transglutaminase

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine


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