American Board of Internal Medicine (ABIM) Certification Practice Exam

What histological changes are classic findings in celiac disease?

1. Intraepithelial lymphocytosis, crypt elongation, and villous blunting

2. Submucosal edema and necrosis

3. Glandular hyperplasia and calcification

4. Granulomas and fibrosis

The correct answer is: Intraepithelial lymphocytosis, crypt elongation, and villous blunting

Celiac disease is characterized by a specific immune response to gluten, leading to a range of histological changes in the small intestine. The classic findings associated with celiac disease include intraepithelial lymphocytosis, crypt elongation, and villous blunting. Intraepithelial lymphocytosis refers to an increased number of lymphocytes present in the epithelial layer of the intestinal mucosa. This indicates an immune-mediated response and is a hallmark of celiac disease. Crypt elongation occurs due to increased proliferation of crypt cells, which is another adaptive response of the intestinal mucosa in response to injury and inflammation. This elongation of the crypts is associated with the chronic nature of the disease and reflects ongoing cellular changes. Villous blunting describes the flattening or shortening of the villi, which are small, finger-like projections that increase the surface area for nutrient absorption in the small intestine. The reduction in villous height significantly impacts nutrient absorption, leading to the malabsorption symptoms commonly seen in celiac disease. These histological changes serve as indicators of celiac disease and are crucial for diagnosis when intestinal biopsies are examined. This cluster of findings effectively captures the underlying pathophysiological response to gluten in susceptible individuals.