Which serologic markers are associated with celiac disease, and what histology is typical?

• A. Anti-dsDNA; granulomas
• B. Anti-HBs; normal mucosa
• C. pANCA; pseudopolyps
• D. Anti-tTG and anti-endomysial antibodies; villous atrophy with crypt hyperplasia

Answer: (D)

Celiac disease is diagnosed by combining specific serologic markers with characteristic small intestine histology. The serologic markers are anti-tissue transglutaminase antibodies (anti-tTG) and anti-endomysial antibodies (EMA). These autoantibodies appear in response to gluten and are highly sensitive and specific for celiac disease, making them the best initial clues when the condition is suspected.

On tissue examination, the typical finding is damage to the intestinal villi: villous atrophy with crypt hyperplasia, accompanied by an increased number of intraepithelial lymphocytes. This pattern reflects gluten-triggered autoimmune injury to the mucosa and explains the malabsorption symptoms often seen in celiac disease.

Other antibodies listed point to different conditions—for example, anti-dsDNA is associated with SLE, anti-HBs with hepatitis B, and pANCA with certain forms of inflammatory bowel disease. Their presence would not explain the small intestinal villous atrophy with crypt hyperplasia seen in celiac disease.