What histologic features define celiac disease in the duodenal mucosa?

What histologic features define celiac disease in the duodenal mucosa?

• A. Villous hyperplasia with crypt atrophy.
• B. Intraepithelial lymphocytes decreased.
• C. Villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes.
• D. Crypt abscesses with mucosal ulceration.

Answer: (C)

In celiac disease the mucosal damage is immune-driven and most clearly seen in the small intestine as loss of the normal absorptive surface. The duodenal mucosa shows villous atrophy, meaning the finger-like villi are blunted or flattened, which reduces nutrient absorption. At the same time, the crypts become hyperplastic as the epithelium turns over more rapidly to repair injury. Lining and interspersed with this active injury is an increased number of intraepithelial lymphocytes, reflecting the immune attack on the mucosa. This combination—villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes—is the hallmark histologic pattern of celiac disease. Why the other patterns don’t fit: villous hyperplasia with crypt atrophy would actually imply more surface area, not the reduced surface area seen in celiac; intraepithelial lymphocytes would be increased, not decreased; and crypt abscesses with mucosal ulceration point more toward other inflammatory bowel diseases rather than classic celiac disease.

In celiac disease the mucosal damage is immune-driven and most clearly seen in the small intestine as loss of the normal absorptive surface. The duodenal mucosa shows villous atrophy, meaning the finger-like villi are blunted or flattened, which reduces nutrient absorption. At the same time, the crypts become hyperplastic as the epithelium turns over more rapidly to repair injury. Lining and interspersed with this active injury is an increased number of intraepithelial lymphocytes, reflecting the immune attack on the mucosa. This combination—villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes—is the hallmark histologic pattern of celiac disease.

Why the other patterns don’t fit: villous hyperplasia with crypt atrophy would actually imply more surface area, not the reduced surface area seen in celiac; intraepithelial lymphocytes would be increased, not decreased; and crypt abscesses with mucosal ulceration point more toward other inflammatory bowel diseases rather than classic celiac disease.