Marsh Scores are what pathologists use to determine the status of someone’s small intestine. But first we need a little vocabulary.

Villi are the small hair-like features that absorb nutrients. They are often damaged in celiac disease.

Intraepithelial lymphocytes (IEL) are white blood cells (part of the immune system) in the mucous membrane of small intestine. There should be fewer than 30 IEL’s per epithelial cells and more than that is significant.

Crypt hyperplasia is the depth of grooves between villi. In normal intestines, these grooves don’t exist.

I’m going to try to describe these damage levels like erosion, so I hope the analogies.

Marsh 0 – Not Celiac – Perfectly healthy small intestine with intact villous architecture, normal intraepithelial lymphocytes, and no crypt hyperplasia.

Think tall and regal mountains like the Rocky Mountains or the Alps.

Marsh 1 – No villous blunting or intact villous architecture and increased IEL’s. No crypt hyperplasia.

Not Celiac, but may be considered partially treated celiac and sometimes latent or potential celiac. There is some damage but does not rise to the pervasive damage characteristic of celiac disease.

Marsh 1 damage is like slightly rounded hilltops worn away, like the Blue Ridge Mountains, but you still know they are mountains.

Additionally, if you were previously diagnosed with celiac disease and this is the result from a follow up endoscopy, this is an excellent result.  Most doctors would say the celiac disease is in remission with this result.

Also, this stage can be caused by a myriad of other diseases, H.pylori, NSAID use, Crohn’s, etc. Often, the biopsy report will say that pathological findings need to be confirmed with blood tests.

Marsh 2 – Rarely diagnosed and often associated with Dermatitis Herpitiformis. This stage is also rarely seen.

Marsh 2 damage is like going to a secret valley and seeing mountains nobody is used to seeing.

Marsh 3 – Active celiac disease. Villi can be slightly shortened to almost gone. IEL’s are increased. Crypt depths are increased. Note that all three pathological symptoms of celiac disease are present. There are grades within Marsh 3, A, B, and C Grade C is the worst with complete villous atrophy.

Think worn away and almost flat or in some cases absolutely flat.  Think Grand Canyon with the worn away rock and deep crevices.

That is Marsh scoring in a nutshell. I think a lot of confusion comes into lay people reading pathology or lab reports that only mention changes in Marsh 1 type damage. Marsh 1 is not considered celiac disease because celiac disease is devastating to the small intestine with characteristic and pervasive damage. The damage is unmistakable.

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