This document summarizes the results of a survey of 14 respondents from BSG-Oslo on their practices related to histopathology in patients with suspected or known celiac disease. Key findings include: 1) The most common biopsy sites for patients with suspected celiac disease were the duodenum, followed by the gastric antrum and body. 2) Most respondents reported having regular review meetings with pathologists to discuss biopsy results and classifications. 3) Respondents used a variety of serology tests for celiac disease including anti-tTG, EMA, and anti-DGP antibodies. 4) There was no consensus on the best single marker for monitoring patient

1. Histopathology-survey
BSG-Oslo [14 respondents]
Jonas, Sept 17, 2012

2. Number of biopsies?
(same results for Ser+ and Ser=unknown)
4 ≥5
10
7.5
5
2.5
0
Biopsies

3. Which sites-suspected CD
(almost same results for Ser+ and Ser=unknown)
D1 D2
Beyond D2 Oesophagus
Gastric Antral
Body
15
12
9
6
3
0
Pos ser Unknown ser

4. Routine CLO-suspected CD
(same results for Ser+ and Ser=unknown) (if unknown: 5
(not 4) would talke a CLO-test)
Yes No
15
12
9
6
3
0
CLO

5. Endoscopy of patients with suspected coeliac disease,
with known pos serology: Do you order any other tests?
Giardia, n=1
No, n=7 [may order other tests when the diagnosis is
confirmed)
Hp-test, n=1
Depends on patient’s symptoms and the mucosal
aspects.

6. Endoscopy of patients with suspected coeliac disease,
with unknown serology: Do you order any other tests?
HLA, n=1
Hp, n=1 [according to mucosal appearance]
SIBO, n=1
Serology, n=4
Nothing (No), n=4

7. Do you have review meetings with the pathologist?
Yes No
weekly, n=8
15 monthly, n=2
12
9
6
3
0
meetings w path

8. Do you as a clinician review the path slides?
sometimes always never
15
12
9
6
3
0
meetings w path

9. Who performs the biopsy interpretations?
pathologist Other
15
12
9
6
3
0
interpretation

10. Do you tell the pathologist Do you tell the pathologist
the serology status if known? other clinical data?
yes no yes no
15 15
12 12
9 9
6 6
3 3
0 0
serology status clinical data

11. Agreed with pathologist
about classification?
yes no
15
12
9
6
3
0
is it possible to agree with a pathologist....?

12. Use the Marsh? (Marsh or Marsh-Oberh, n=12)
if no, What classifications?
yes no
Stand Marsh, n=1
15
Marsh-Oberhuber, n=5
Corazza-Villan, n=2
12
Italian IAP VIllan, n=0
9
Other, n=7
6
3
0 Descriptive, n=2
Marsh

13. Does your hospital have a
If a standardized report is
standardized histo report/
missing, would you like one?
checklist?
yes no yes no
15 15
12 12
9 9
6 6
3 3
0 0
checklist Would you like a checklist?

14. Which features are important to
state in the histo report?

15. Routine use of when do you use
immunohistochemistry immunohistochemistry?
yes no borderlne cases
only if increased
Other
15 15
12 12
9 9
6 6
3 3
0 0
immunohistoch when immunohistoch?

16. Do you get a purely histopath
IELs, what is the norm?
report?
20 25 Other yes no
15 15
12 12
9 9
6 6
3 3
0 0
IELs purely histo
Normal histo, pathologist recommends serolgy: 11/16 yes

17. Are the new ESPGHAN criteria accepted in your
country?
yes no
15
12
9
6
3
0
Marsh

18. What serology do you use?
antigliadin anti-TG2
anti-DGP EMA, IgA
EMA, IgG Other
15
12
9
6
3
0
serology test

19. Best marker of dietary Asymptomatic patient with
adherence? sero+ and VA
symptom relief No need follow GFD
antiobdy seroconversion Start GFD
histo recovery Start GFD, follow-up with sero only
Other Start GFD, follow-up with sero and histo
15 15
12 12
9 9
6 6
3 3
0 0
Marker-adherence what do we do?
Consider all the above, n=2

20. Persistent VA in
asymptomatic patients on
GFD is no concern?
strongly agree
Agree
Neither agree/disagree
Strongly disagree
15
12
9
6
3
0
Marker-adherence

21. In the definition of refractory
CD which of the following
are signs of malabsorption?
iron deficiency
folate deficiency
osteoporosis
bloating, abd pain, diarrhea*
15
12
9
Of those responding
6 bloating etc, 2
indicated that these
3 were symptoms that
responded to dietary
0 fibre exclusion
Marker-adherence

22. TTG+ patient with VA after
12 months despite dietary
adherence, what do you
consider?
steroids
repeat biopsy (flow cytometry, immunohistoch, TCR clonal)
Watch longer
assume residual gluten (food diary etc)
Trial liquid/elemental diet
15
12
9
6
3
0
what to do?

23. Patient with severe subtotal
VA on diagnostic biopsy
always have symptoms
always have detectable nutritional deficiencies
can be entirely asymptomatic
always sero+
15
12
9
6
3
0
what to do?

24. A patient with exceptionally (and unquestionably) good
gluten free dietary compliance (on a ‘supersensitive diet –
excluding all codex wheat products and barley malt extract)
has persisting sub total villous atrophy on repeat biopsy at 12
months and 24 months, but was asymptomatic at presentation
and follow up with normal weight and blood tests. A TTG
titre of 120 normalised to 2 after 6 months on diet and has
persisted at this low level...
no concern
15 not constitute RCD
should be considered histologically refractory (+ c
12 steroid trial
steroids and/or azathioprine
9
6
3
0
what to do?

25. If you endoscope for other clinicians do you get the
report sent directly to them for their attention? or do you
see this and act on it? Example 2: If this is not your
patient does the requesting physician have this
responsibility?
Requesting physician (Yes), n=8
Sometimes (both my and their responsibility), n=2
My responsibility, n=1-2

26. If you endoscope for other clinicians do you get the report
sent directly to them for their attention? or do you see this
and act on it? Example 3: How do you investigate these
patients if serology for coeliac disease is negative?
HLA, n=5
Hp, n=4 (CLO or fecal antigen)
Parasites, N=1
NSAID’s history, n=1
IgA levels; n=2
Review the slides myself

27. When do you use
immunocytochemistry?
Refractory, n=3
Problematic cases, n=1

28. Best marker of response to
treatment with GFD
Consider all together, n=2
Combine clinics and serology, n=1