Taavela (19) reported that the Marsh classification "is often too imprecise (how often, and in what way, might we ask?) and ignores minor but significant changes in mucosa." Unfortunately, the "minor but significant changes" have not been highlighted.
The simplistic nature of the Marsh classification with two or three basic categories was unfortunately confused by the later attempts to standardize it (47).
Modified Marsh Classification was used to grade the histopathology of biopsy samples.
Investigation of celiac disease according to Marsh classification in childhood.
All the cases were classified according to the Marsh classification
Variable Frequency Percentage Sex Female 49 60.5 Male 32 39.5 Diabetes Yes 20 24.7 No 61 75.3 Hypothyroidism Yes 10 12.3 No 71 87.7 Gastrointestinal symptoms Yes 38 46.9 No 43 53.1 Short stature Yes 38 46.9 No 43 53.1 Family history of celiac Yes 21 25.9 No 60 74.1 Histopathology changes Yes 66 81.5 No (silent) 15 18.5 Marsh grading of histopathology changes Marsh 0 15 18.5 Marsh I 3 3.7 Marsh II 14 17.3 Marsh III 49 60.5 tTG titer <180 30 37 [greater than or equal to] 180 51 63 TABLE 2: Marsh classification
and anti-tTG titer cross tabulation.
 found that the stage of duodenal mucosal injury (following Marsh classification
) was the most important factor in determining low BMD at diagnosis but they considered differences between Marsh I, Marsh II, and Marsh III grades unlike our study design.
Categorizing cases of celiac disease using the Marsh classification
yielded one case of class 0, 5 cases of class 2, 10 cases of class 3a, 19 cases of 3b, and 1 case of class 3c.
According to the modified Marsh classification
, (5) the results were consistent with CD, type 3B (Figure 1).
Recently, Ensari has proposed an updated version of the time-honored Marsh classification
, which is much simpler, and user-friendly from a pathologist\'s point of view.6 However, it needs to be validated in prospective studies in different centers of the world before it can get widespread acceptability.
will be discussed in detail in association with other classification schemes in the following sections.
Table 2 also shows the histological characteristics of small-bowel biopsies according to the modified Marsh classification
. Only a minority of patients had mild histological changes (Marsh type II and IIIa); most patients showed severe villous atrophy (Marsh IIIb or IIIc).