Celiac Disease: An Assessment of Subjective Variation and Diagnostic Reproducibility of the Various Classification Systems

Abstract

Introduction: Celiac disease (CD) is a chronic immune mediated disorder occurring in genetically predisposed individuals with intolerance to gluten, particularly its protein gliadin. The histological examination still remains the gold standard for its diagnosis. Marsh-Oberhuber classification is very widely used by pathologists for the diagnosis of CD and is valid under optimal clinical conditions. However, due to the presence of greater diagnostic categories, it lends itself to greater subjective variability and lower interobserver and intraobserver agreement and hence lower reproducibility of the diagnosis. Recently, Corazza and Villanacci introduced a classification that reduces the number of categories and the interobserver variation. This study was undertaken to observe the reproducibility of the Marsh-Oberhuber classification in comparison to the newer Corazza and Villanacci classification and determine the intra and interobserver variation in both the classifications.