Histopathological and demographic patterns of celiac disease: a pathology-based study
Abstract
Background. Celiac disease (CD) is an autoimmune disorder of the small intestine related to gluten intolerance in genetically predisposed individuals. This study aimed to estimate the relative distribution of age and sex among patients with histopathological findings suggestive of CD in relation to the Marsh classification in Basrah. Methods. A prospective pathology-based cross-sectional study was conducted on 469 duodenal biopsy specimens collected between January 2023 and March 2025 from Al-Sadder Teaching Hospital and multiple private pathology laboratories in Basrah. The samples were evaluated according to the Marsh classification. The distribution of Marsh lesions was analyzed according to age and sex and compared with findings reported in previous studies. Result. The study identified 121 Marsh III lesions suggestive of CD. These lesions were more frequent among biopsy specimens from males than from females. Marsh classification was analyzed in relation to age: in the <15-year age group, Marsh IIIa was observed in 12 cases and Marsh IIIb in 24 cases, giving a total of 36 Marsh III cases; in the 15–40-year age group, Marsh IIIa was observed in 68 cases, Marsh IIIb in 12 cases, and Marsh IIIc in 5 cases, giving a total of 85 Marsh III cases; and in the >40-year age group, only 4 cases of Marsh II were observed, with no Marsh III cases detected. Overall, 121 Marsh III cases suggestive of CD were identified: 36 in patients younger than 15 years and 85 in patients aged 15–40 years; no Marsh III cases were identified in patients older than 40 years. Conclusion. In this pathology-based sample, Marsh III lesions suggestive of CD were more frequent in pediatric and young adult patients and were not identified in patients older than 40 years. Because the study was based on selected biopsy specimens and did not include serological or clinical confirmation, the findings should not be interpreted as estimates of CD prevalence in the general population. Larger studies combining histopathology, serology, and clinical data are needed to better define the diagnostic patterns of CD in Basrah.