Type 1 Marsh Celiac Disease: Diagnosis and Response

Fernando Fernández Bañares, Meritxell Mariné, Mercè Rosinach, Anna Carrasco, Maria Esteve


The histological Marsh classification distinguishes three types of lesion, among which gluten-sensitive enteropathy with a Type 1 Marsh lesion is the most difficult to diagnose. Unlike Marsh 3 lesion, which almost always corresponds to celiac disease, Marsh 1 lesion has a wider differential diagnosis. This is further compounded by the absence of celiac disease-specific antibodies in up to 80% of the patients with a Marsh 1 lesion. For all these reasons, gluten-sensitive enteropathy diagnosis in Marsh type 1 lesions has become a challenge for clinicians. In recent years, new diagnostic techniques have emerged in order to distinguish gluten-dependent from non-gluten dependent Marsh 1 lesions. In this sense, the presence of transglutaminase IgA subepithelial deposits or increased intraepithelial lymphocytes expressing TCR gamma/delta in the duodenal mucosa strongly suggest the diagnosis of celiac disease. Another important issue is to determine which patients with a Marsh type 1 lesion should be treated. It should be noted that up to 50% of patients with minimal lesions present the same symptoms as those with Marsh 3 lesion, which suggests that they will benefit from a Gluten Free-Diet (GFD). Ultimately, the diagnosis of celiac disease cannot rely on the results of a single test and requires a good understanding of clinical, serological, genetic and histological criteria and of the GFD response.

Palabras clave

celiac, type 1 marsh, diagnosis

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