<<Disclaimer: Verify this information before applying it to your situation.>>
 
There is much variation in the findings seen on biopsy of the intestine in
celiac disease.  There are also many conditions that can mimic the
pathological finddings of celiac disease.  However in adults in the US other
causes for complete villous atrophy with inflammation are unusual except in
well defined and often easily recognised circumstances.
 
The major area of debate centers in the less that classic biopsy.  often
times these biopsies may be interpreted as non-specific inflammation and
celiac disease discounted as a possibility.  However in some cases on review
and with the benefit of hidsight the biopsies may have had subtle findings
that would allow a more specific identifaction or at least suspicion for
celiac disease to be entertained.  Are there any intraepithelial lymphocytes,
is there crypt hyperplasia ( thickening of the basement level of the lining)
enethough some tall villi can be seen.
 
This can be a difficult area for the pathologist to deal with, coorelation
with the clinical picture is essential to put it all together, this gets even
more challenging as the definition of what constitutes celiac disease may
change somewhat.
 
This is just one challenge that celiac disease presents for patients,
parents, doctors, and pathologists.
 
Joe Murray
Not medical advice