Increasing popularity of serologic and permeability studies in patients investigated for possible celiac disease has resulted in a growing awareness among clinicians that currently accepted histologic criteria for diagnosis of celiac disease lack sensitivity. The patients who improve on a gluten-free diet with abnormal findings from serologic and permeability studies may have normal or “almost” normal villous/crypt morphology. The population of intraepithelial lymphocytes once extensively discussed in the literature may after all prove useful in identifying the individuals who may benefit from dietary gluten withdrawal. A recently outlined spectrum of the mucosal pattern (M. N. Marsh), which may be seen in the gluten-sensitive enteropathy is valuable in assessing histomorphology of small bowel biopsies from the patients investigated for celiac disease.
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