Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2019; 25(20): 2402-2415
Published online May 28, 2019. doi: 10.3748/wjg.v25.i20.2402
From 2-dimensional to 3-dimensional: Overcoming dilemmas in intestinal mucosal interpretation
Richard PG Charlesworth, Michael N Marsh
Richard PG Charlesworth, School of Science and Technology, University of New England, Armidale, NSW 2351, Australia
Michael N Marsh, Wolfson College, University of Oxford, Oxford OX2 6UD, United Kingdom
Author contributions: Both Marsh MN and Charlesworth RPG designed and jointly wrote the manuscript.
Conflict-of-interest statement: The authors have no financial, professional, or personal conflicts of interest relevant to the manuscript to declare.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Richard PG Charlesworth, PhD, Lecturer, School of Science and Technology, McClymont Building, University of New England, Armidale, NSW 2350, Australia. rcharle3@une.edu.au
Telephone: +61-2-67731512
Received: February 6, 2019
Peer-review started: February 6, 2019
First decision: March 27, 2019
Revised: April 4, 2019
Accepted: April 19, 2019
Article in press: April 20, 2019
Published online: May 28, 2019
Abstract

The purpose of this review is to provide a definitive account of small intestinal mucosal structure and interpretation. The coeliac lesion has been well known, but not well described to date and this review aims to identify the interpretative difficulties which have arisen over time with the histological assessment of coeliac disease. In early coeliac interpretation, there were significant inaccuracies, particularly surrounding intraepithelial lymphocyte counts and the degree of villous flattening which occurred in the tissue. Many of these interpretive pitfalls are still encountered today, increasing the potential for diagnostic errors. These difficulties are mostly due to the fact that stained 2-dimensional sections can never truly represent the 3-dimensional framework of the intestinal tissue under investigation. Therefore, this review offers a critical account occasioned by these 2-dimensional interpretative errors and which, in our opinion, should in general be jettisoned. As a result, we leave a framework regarding the true 3-dimensional knowledge of mucosal structure accrued over the 70-year period of study, and one which is available for future reference.

Keywords: Coeliac disease, Histology, Diagnosis, 2-dimensional, 3-dimensional

Core tip: The purpose of this review is to provide a definitive account of small intestinal mucosal structure and interpretation. We offer a critical account and give opinion that current testing protocols need to be altered. We then leave a framework regarding the true 3-dimensional knowledge of mucosal structure accrued over the 70-year period of study, and one which is available for future reference.