Intestinal Biopsy in the Diagnosis of Celiac Disease: Is it Still the Gold Standard?

Pathology plays a crucial role in the diagnosis of celiac disease (CD). The pathologist’s role is to confirm the diagnosis of cd; to exclude other diseases that share morphologic features with cd and to diagnose complications in patients with CD.  Therefore, the significance of the small bowel biopsy includes confirming the diagnosis but also reassuring the clinician that other etiologies are excluded. Some of these diseases share many similarities with cd, such as villous atrophy and intraepithelial lymphocytosis, and the small bowel biopsy helps with this distinction. The use of standarized pathology reporting including the appropriate classification system is highly recommended in order to facilitate the interpretation of the pathology report and the communication between pathologists and clinicians. Despite the need for a small bowel biopsy in the initial work up of CD, some patients and particularly children, may be spared a small bowel biopsy if certain clinical and laboratory findings are present in order to confirm the diagnosis without a biopsy.It is important to emphasize that the pathologic findings need to be correlated  with the clinical, endoscopic and serologic findings in all the patients suspected of CD.