Table 1.

Histologic grading of duodenal mucosal changes in celiac disease according to modified Marsh criteria

STAGE	MUCOSAL CHANGE	DESCRIPTION
0	Normal	Normal mucosal architecture
I	Infiltrative	Normal mucosal architecture Villous epithelium is infiltrated by lymphocytes (> 30 per 100 enterocytes)
II	Hyperplastic	Crypt hyperplasia with infiltration of inflammatory cells
III	Villous atrophy
IIIa	• Partial	Shortened blunt villi associated with mild infiltration of lymphocytes and crypt hyperplasia
IIIb	• Subtotal	Clearly atrophic villi but still recognizable Signs of crypt hyperplasia and inflammatory cell infiltration are increased
IIIc	• Total	Nearly total absence of villi Severe atrophic, hyperplastic, and infiltrative lesions
IV	Hypoplastic	Total villous atrophy Crypt hypoplasia Normal intraepithelial lymphocyte count

Adapted from Buchman.⁴⁵