Is hyperhomocysteinemia relevant in patients with celiac disease?

Table 1 The Marsh-Oberhuber classification of duodenal histological lesions in celiac disease, compared to the “simplified classification”[11,12]

Histologic type	IEL	Glandular crypts	Villi	Simplified
0	Normal (< 25/100 epithelial cells)	Normal	Normal	Normal
1	Increased	Normal	Normal	Grade A
2	Increased	Hyperplastic	Normal	Grade A
3a	Increased	Hyperplastic	Mild atrophy	Grade B1
3b	Increased	Hyperplastic	Moderate atrophy	Grade B1
3c	Increased	Hyperplastic	Severe (total) atrophy	Grade B2

IEL: Intra-epithelial lymphocytes.

Table 2 Demographic, histological findings and associated diseases of 32 celiac disease patients with hyperhomocysteinemia

No.	Sex/age (yr)	Histology (Marsh/simplified classification)	Associated diseases
1	F/37	Marsh 2 (Grade A)	IgA deficit
2	F/38	Marsh 3a (Grade B1)
3	M/34	Marsh 3a (Grade B1)
4	F/32	Marsh 3c (Grade B2)
5	F/20	Marsh 3c (Grade B2)
6	F/47	Marsh 3b (Grade B1)
7	F/64	Marsh 1 (Grade A)
8	F/41	Marsh 3c (Grade B2)	Epilepsy
9	F/22	Marsh 2 (Grade A)	IgA deficit
10	F/61	Marsh 3a (Grade B1)
11	M/44	Marsh 3c (Grade B2)	NASH
12	F/35	Marsh 3c (Grade B2)	type 1 diabetes
13	F/39	Marsh 3c (Grade B2)
14	F/40	Marsh 3c (Grade B2)
15	F/56	Marsh 3c (Grade B2)	PBC
16	F/35	Marsh 3c (Grade B2)
17	F/42	Marsh 2 (Grade A)
18	M/33	Marsh 3b (Grade B1)	Sarcoidosis
19	F/31	Marsh 3a (Grade B1)
20	F/42	Marsh 3a (Grade B1)
21	M/28	Marsh 3a (Grade B1)
22	F/41	Marsh 3c (Grade B2)
23	F/45	Marsh 3c (Grade B2)
24	F/21	Marsh 3a (Grade B1)
25	F/29	Marsh 3b (Grade B1)
26	F/55	Marsh 3a (Grade B1)	Osteoporosis
27	F/78	Marsh 3c (Grade B2)
28	M/47	Marsh 3c (Grade B2)
29	M/63	Marsh 3b (Grade B1)	Psoriasis, myocardial infarction
30	M/18	Marsh 3a (Grade B1)
31	M/40	Marsh 1 (Grade A)
32	F/32	Marsh 3a (Grade B1)	Sarcoidosis

IgA: Immunoglobulin A; PBC: Primary biliary cirrhosis.

Table 3 Serologic findings of 32 celiac disease patients with hyperhomocysteinemia

No.	Serum homocysteine (NV 5-15 μmol/L)	Serum B12 vitamin (NV 190-66 pg/mL)	Serum folic acid (NV 2-14 ng/mL)	Genetic mutation
1	14	365	10
2	13.5	267	4.7
3	15	369	6
4	20	356	1
5	13	174	5	MTHFR (het)
6	21	311	1.5
7	15	354	12
8	44	293	5.2	MTHFR (hom)
9	15	493	6	MTHFR (hom)
10	17	333	1	MTHFR (het)
11	19	383	3
12	17	198	2
13	15	400	3	MTHFR (het)
14	27	720	4	MTHFR (hom)
15	13	699	3	MTHFR (hom)
16	21	246	2.4
17	18	265	5.1
18	19	282	1	Prothr (het)
19	20	457	3	MTHFR (hom)
20	14	555	0.5
21	13	291	2
22	23	280	6
23	14	329	1	MTHFR (het)
24	17	684	10
25	19	566	5.6
26	20	188	2
27	20.5	154	3
28	20.5	216	2	MTHFR(het)
29	16	164	13	MTHFR (het)
30	25	555	8
31	149	150	2	MTHFR (hom)
32	31	385	2	MTHFR (hom)

het: Heterozygosis; hom: Homozygosis; MTHFR: N5-N10-metil tetrahydrofolate reductase.