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

Document Type : Original Article

Authors

Department of Pathology, School of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

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.

Keywords

References

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World Journal of Peri & Neonatology
Volume 7, Issue 2
October 2025

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History

  • Receive Date: 11 November 2025
  • Accept Date: 11 November 2025

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