Marsh described different histopathologic patterns in small bowel biopsies that reflect the progression of gluten-sensitive enteropathy (celiac disease). This can help identify patients prior to onset of the clinical enteropathy.
Parameters:
(1) lymphocytosis within the surface epithelium of small intestinal villi
(2) mitotic activity in crypts
(3) change in villous architecture (progressive villous atrophy)
Lymphocytosis per 100 Enterocytes
Mitotic Activity in Gland Crypts
Villous Atrophy (VA)
Marsh Type
<= 30
normal
none
NA
> 30
normal
none
I
> 30
increased
none
II
NA
NA
partial
IIIa
NA
NA
subtotal
IIIb
NA
NA
total
IIIc
where:
• The subtypes to Marsh Type III are from Tursi and Brandimarte.
• Type I lesions are referred to as "infiltrative".
• Type II lesions are referred to as "infiltrative/hyperplastic" or "proliferative".
• Type III lesions are referred to as "partial/total villous atrophy".
The presence of increased lymphocytes in the surface epithelium is nonspecific. Other conditions that can result in intraepithelial lymphocytosis with normal villous architecture (Kakar et al):
(1) autoimmune disease
(2) NSAID use
(3) Crohn's disease
(4) lymphocytic or collagenous colitis
(5) bacterial overgrowth syndrome
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