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Is a detailed grading of villous atrophy necessary for the diagnosis of enteropathy?
  1. Federico Biagi1,
  2. Claudia Vattiato1,
  3. Marco Burrone2,
  4. Annalisa Schiepatti1,
  5. Simona Agazzi1,
  6. Gregorio Maiorano1,
  7. Ombretta Luinetti3,
  8. Costanza Alvisi1,
  9. Catherine Klersy4,
  10. Gino Roberto Corazza1
  1. 1First Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  2. 2Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
  3. 3Department of Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  4. 4Biometry and Statistics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  1. Correspondence to Professor Federico Biagi, Coeliac Centre, First Department of Internal Medicine, Policlinico San Matteo, Viale Golgi, 19, Pavia 27100, Italy; f.biagi{at}


Aims The utility of the 7 level Marsh–Oberhuber classification of mucosal damage in patients with coeliac disease has recently been criticised. Analysis of duodenal biopsies with dissecting microscopy is an unsophisticated method that, however, provides useful information in cases of frank villous atrophy. In the last 15 years, we have always analysed duodenal biopsies with dissecting microscopy before sending them to the pathology department for histology. If the results of dissecting microscopy and traditional histology were comparable, we feel that would be strong evidence that grading of the histological lesion would be unnecessary if not pointless in the everyday diagnosis of enteropathies.

Methods The clinical notes of all 2075 patients undergoing duodenal biopsy between September 1999 and June 2015 were retrospectively analysed. Results of duodenal mucosal evaluation with both dissecting microscopy and traditional histology were collected and statistically compared.

Results The κ statistics showed a substantial agreement of the two methods (κ statistics 0.78). Sensitivity of dissecting microscopy for detection of severe villous atrophy was 85.1% (95% CI 81.2% to 88.5%) and specificity was 95% (95% CI 93.8% to 96%).

Conclusions Although dissecting microscopy is an unsophisticated method that obviously cannot substitute traditional histology, our results suggest that in everyday clinical practice, the diagnosis of coeliac disease and other flat enteropathies does not require grading of villous atrophy.


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  • Handling editor Cheok Soon Lee

  • Contributors FB set up the study, performed the DM analysis and wrote the manuscript together with GRC; CV and MB collected the clinical data and took care of the patients together with AS, SA and GM.; OL performed the TH analysis; CA performed the endoscopy together with CV; CK performed the statistical analysis.

  • Competing interests None declared.

  • Ethics approval Ethics committee of the Fondazione IRCCS Policlinico San Matteo.

  • Provenance and peer review Not commissioned; externally peer reviewed.