Coeliac disease, mucosal change and IEL: doing what counts the best.

There has been a flurry of activity in GHFBB arising from my classification (1), and I am flattered that the editors have now asked me for an overview. Readers should note that the flurry originated from a recent paper (2) in which we revealed the redundancy of Oberhuber's re-classification of the Marsh III coeliac lesion. First, we indicated that there is no structural basis for his assertion. Second, there is a need to recognise that his subdivisions have never offered useful contributions either to diagnosis, response to treatment, or longer-term outlook. So why use them? And, for those who had the initiative to enquire, no correspondence exists between Oberhuber's subdivisions (despite their technically poor quality) and those of others (3), despite both being offered as supportive guides for histopathologists. That observation emphasises the subjectivity of the exercise. But that revelation hardly surprises, since no structural criteria were ever produced to guarantee reproducibly standard sub-classifications. That is the impasse, but one which is easily by-passed.