Thanks for writing this interesting and informative practice guideline. I only have a few minor comments:
1. p.21 second bullet point – could this language be softened to note that “…comparison to prior biopsies may be helpful, if clinically indicated/requested.”
2. Figure 3 legend, last sentence – could this language be softened to note that “…villous blunting, and may compare the villous architecture in patients with existing previous biopsies of suspected or proved celiac disease, if clinically indicated/requested.”
3. Table 2 – it may be helpful to mention that IELs in tropical sprue typically more numerous in the crypts than in the surface epithelial cells
This is a superb review of the histopathologic findings in Celiac disease. It may be that it is assumed that serologic testing would precede performance of endoscopy, but a statement specifically recommending testing for IgA anti-tissue transglutaminase (TTG) and IgG and IgA anti-deamidated gliadin prior to endoscopy could help exclude unlikely cases. Further, testing for HLA-DQ2 and HLA-DQ8 are useful for excluding unlikely candidates for the disease.
Duodenal biopsies are the most frequently disrupted samples among all the different mucosal types we get from the GI tract. The villi are frequently ripped away from the surface and the biopsies are crushed or otherwise mangled. I get good results educating my clinicians that duodenum needs the most gentle handling of all GI mucosal biopsies when it is transferred from the forceps to the fixative. This might be a useful addition to the introductory comments of this review. Thank you for writing this excellent review!