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MORPHOLOGICAL SPECTRUM OF MUCOSAL LESIONS IN CLINICALLY SUSPECTED CELIAC DISEASE AND COMPARISON WITH SEROLOGYDr. Nusrat Zahra
MBBS
Supervisor:
Professor Dr. Anwar-ul-Haque
Diplomat American Board of Pathology
Fellow College of American Pathologists
Pathology Department
Pakistan Institute of Medical SciencesDate: 22-02-10SUPERVISORS CERTIFICATE
I, hereby certify that Dr. Nusrat Zahra
Having enrolment number: F-03-24803And RTMC Registration number: HSP-2005-042-208
Has been working under my direct supervision with effect from: 01.03.06 to date.
In the department of Pathology
Of Training Institution: Pakistan Institute of Medical Sciences
In the City of: Islamabad
The dissertation titled, Morphological Spectrum of Mucosal Lesions in Clinically Suspected Celiac Disease and Comparison with Serology, was prepared according to the FCPS Dissertation Guidelines under my direct supervision. I have read the Dissertation and have found it satisfactory for FCPS part II examination in the subject of Pathology.
Signature of Supervisor:
Professor Dr: Anwar-ul-Haque
Official stamp:
Date: 22 -02-10I am indebted to Professor Anwar-ul-Haque who motivated and guided me through every step of the way. I would also like to thank the technical staff without whose help; the assignment would not have been possible. I have deep regards for the gastroenterology department who cooperated with me fully during my study.
I would also like to take this opportunity to thank my parents who have encouraged and believed in me throughout my life.
And most importantly, I would like to thank Allah Almighty, without whose will no vision can ever become a reality.TABLE OF CONTENTSCONTENTS
PAGE NO.
PART I
Acknowledgementiii
List of Tablesv
List of Figuresvi
List of Abbreviationsvii
PART II
Abstract 1
Introduction 3
Review of Literature
7
Objective
30
Operational definitions31
Material and Methods
32
Results
37
Discussion
54
Conclusion
65
References
66
Annexes 86
LIST OF TABLES
Serial No.Page No.
i. Table 1The Modified Marsh Classification36
ii. Table 2Frequencies of Comorbid Disease, and Symptoms for various Marsh grades40
iii. Table 3Patient age and frequencies of gender for various Marsh grades41
iv. Table 4Frequencies of positive and negative tTGA (IgA/M) serology for various Marsh grades42
v. Table 5Frequencies of positive and negative AGA (IgA) serology for various Marsh grades43
vi. Table 6Patient characteristics and Marsh grading in cases with High grade Marsh lesions and positive tTGA (IgA/M) serology44
vii. Table 7Patients with discordant Serology and Histology45
LIST OF FIGURESSerial No.Page No.
i. Figure 1Age- Distribution of Male Patients46
ii. Figure 2Age Distribution of Female Patients47
iii. Figure 3Gender distribution of clinical symptoms in patients clinically suspected of Celiac disease48
iv. Figure 4Duodenal Biopsy showing Modified Marsh Type 1 lesion49
v. Figure 5Duodenal Biopsy showing Modified Marsh Type 3a Lesion50
vi. Figure 6Duodenal Biopsy showing Modified Marsh Type 3b Lesion51
vii. Figure 7Duodenal Biopsy showing Modified Marsh Type 3c lesion52
viii. Figure 8Duodenal biopsy showing Modified Marsh Type 3c Lesion53
LIST OF ABBREVIATIONSi. AGAAntigliadin antibody
ii. AGAAmerican Gastroenterological Association
iii. ARA Antireticulin antibodies
iv. CD Celiac disease
v. CTComputerized tomography
vi. DHDermatitis herpetiformis
vii. EATLEnteropathy-associated T-cell lymphoma
viii. EGD
Esophagogastroduodenoscopy
ix. ELISA Enzyme-linked immunosorbent assay
x. EMAEndomysial antibody
xi. ESPGHAN European Society for Pediatric Gastroenterology, Hepatology and Nutrition
xii. GFD Gluten-free diet
xiii. GI Gastrointestinal
xiv. GSGluten-sensitivity
xv. H&E Hematoxylin and eosin
xvi. HLAHuman leukocyte antigen
xvii. IBSIrritable bowel syndrome
xviii. IDAIron deficiency Anemia
xix. IELs
Intraepithelial lymphocytes
xx. IgAImmunoglobulin A
xxi. IgG
Immunoglobulin G
xxii. IgMImmunoglobulin M
xxiii. NIHNational Institute of Health
xxiv. NSAIDsNonsteroidal anti-inflammatory drugs
xxv. NK cells Natural killer cells
xxvi. PASPeriodic acid Schiff
xxvii. PETPositron emission tomography
xxviii. PIMS
Pakistan Institute of Medical Sciences
xxix. SIBOsmall intestinal bacterial overgrowth
xxx. SPSSStatistical Package for Social Sciences
xxxi. TCRT cell receptor
xxxii. tTG
Tissue transglutaminase
xxxiii. tTGA Tissue transglutaminase antibody
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