Table 3.

Modified Marsh Classification of histological findings (Oberhuber) in patients with concomitant CD and patients with CD alone at baseline and after GFD

Marsh modified (Oberhuber)	Group
Class	Concomitant NAFLD and CD n=101		P value before versus after GFD	CD n=30		P value before versus after GFD	P value between concomitant NAFLD and CD and CD alone
	Before GFD N (%)	After GFD N (%)		Before GFD N (%)	After GFD N (%)
Type 0	0	13 (12.871)	<0.0001**	0	42 (84)	<0.0001**	Before GFD: 1.000 After GFD: 0.0306
Type 1	0	79 (78.217)	<0.0001**	0	8 (16)	<0.0001**	Before GFD: 1.000 After GFD:<0.0001
Type 2	1 (0.99)	2 (1.98)	0.4448	3 10)	0	<0.0001**	Before GFD: 0.3830 After GFD:<0.0001
Type 3a	63 (62.376)	7 (6.93)	<0.0001**	12 (40)	0	<0.0001**	Before GFD: 0.2654 After GFD:<0.0001
Type 3b	23 (22.772)	0.	<0.0001**	9 (30)	0	<0.0001**	Before GFD: 0.2094 After GFD:<0.0001
Type 3c	14 (13.861)	0	<0.0001**	6 (20)	0	<0.0001**	Before GFD: 0.3991 After GFD: 1.0000
Complete histological improvement (n (%))	23 (22.772)			42 (84)			p<0.0001
Partial histological improvement (n (%))	69 (68.316)			8 (16)			p<0.0001
No improvement (n (%))	9 (8.91)			0			p<0.0001

Histological classification is according to Modified Marsh Classification of histological findings in CDceliac disease (Oberhuber).⁴² The classification depends on assessment of four indicators: IEL/100 (intraepithelial lymphocytes) enterocytes jejunum, IEL/100 enterocytes duodenum, crypts hyperplasis and villi.

Classification:

type 0: normal mucosa; type 1: seen in patients on GFD (suggesting minimal amounts of gluten or gliadin are being ingested); patients with dermatitis herpetiformis; family members of patients with CD, not specific, may be seen in infections; type 2: seen occasionally in dermatitis herpetiformis; type 3: spectrum of changes seen in symptomatic CD.

The same classification system was used to assess the endoscopic appearance before GFD and 1 year after beginning the GFD; the endoscopist who performed the follow-up gastroscopy was unaware of the baseline endoscopic appearance. Complete histological improvement is defined as resolution of villous atrophy associated with the absence of crypt hyperplasia and ≤40/100 intraepithelial lymphocytes. Partial histological recovery is defined as improvement of at least one grade on the Marsh classification compared with the initial histology.

**Significant at p<0.05.

CD, coeliac disease; GFD, gluten-free diet; NAFLD, non alcoholic fatty liver disease.