The ratio of villous height to crypt depth can be helpful in evaluating a patient with celiac disease.
Method: The most severely affected area is selected. Microscopic measurements of at least 3 villous-crypt units in an adequate small bowel biopsy, selecting well-oriented units.
Parameters:
(1) villous height in microns
(2) crypt depth in microns
villous height to crypt depth ratio =
= (villous height) / (crypt depth)
Interpretation:
• The normal ratio is >= 2.0.
• Taavela, Koskinen et al used a change of 0.5 (later reduced to 0.4) to determine a clinically relevant change in the effect of a gluten-free diet.
Ratio
Interpretation
>= 2.0
normal
0.9 to 1.9
partial villous atrophy
0.1 to 0.8
subtotal
0
total villous atrophy
Limitations:
• It is important to select well-oriented villous-crypt units and to avoid tangentially cuts. Serial sections may be helpful in selecting the optimum cross section.
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