Celiac Disease With Mild to Moderate Histological Changes Is a Common Cause of Chronic Diarrhea in Indian Children

摘要

Poddar and Yaccha suggest that there is some misinterpretation of the grading system put forward by Marsh. However, we fully explained our grading system that was clearly stated as a modification of the Marsh system, incorporating villous crypt ratios that have been used to define pediatric enteropathies and have been substantiated by morphometric evaluation. Subtotal villous atrophy is an unclear term, and we avoided using it.We did not state that most Indian children with celiac disease (CD) have mild to moderate changes. In the children we studied, we reported that an equal percentage had moderate and severe histologic diagnosis, and we concluded, at the end of the discussion, that CD in India has a heterogeneous histologic presentation. One third of the cases with a mild enteropathy had CD (19/57). We feel that these are reasonable points to make and are particularly important in a setting where the diagnosis of CD may be missed or delayed if it is based only on severe mucosal changes.