Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy

Dickey, William; Hughes, D.

doi:10.1111/j.1572-0241.2001.03947.x

Cited by 103 publications

(34 citation statements)

References 16 publications

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“…For example, scalloping or loss of duodenal folds, mosaic pattern, and nodularity can serve as endoscopic markers of the disease [6,7,9,10]. These observations may indicate a need for duodenal biopsies in patients that present both typical and atypical presentations of CD.…”

Section: Isrn Endoscopymentioning

confidence: 99%

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

et al. 2013

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Background. European studies have shown the utility of limiting endoscopic biopsies to diagnose celiac disease (CD) to patients that have high-risk symptoms or present with positive serology. However, many centers in the U.S. have open access endoscopy. Patients are referred without prior serologic testing, and endoscopists often decide whether or not to biopsy at the time of procedure. Aims. Evaluate the yield of duodenal biopsies for the diagnosis of CD in patients undergoing upper endoscopy without prior serologic testing. Methods. This retrospective study evaluated the frequency of CD diagnosis based duodenal biopsies. Researchers were interested in the yield of endoscopic stigmata findings in patients with high-risk symptoms versus low risk. Results. Eight hundred and ten patients met entry criteria at the Cleveland Clinic Florida between 2004 and 2008; 320 presented with highrisk symptoms; and 490 low risk. Sixty-one (7.5%) displayed endoscopic stigmata, and 10/61 (16.3%) were diagnosed with CD. Only patients who exhibited endoscopic stigmata were later diagnosed based on histologic findings. The presence of endoscopic stigmata greatly increased the probability of diagnosing CD, with a positive likelihood ratio of 15.6. Conclusions. When performing upper endoscopy without known serological markers for CD, clinicians should limit duodenal biopsies to patients with high-risk symptoms or endoscopic stigmata.

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Section: Isrn Endoscopymentioning

confidence: 99%

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

et al. 2013

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“…Not all patients with CD manifest classical histopathology of CD; hence, a significant number of patients with gluten-sensitive enteropathy may not be recognized by the histological criteria (1,7,16,17,22). Delays in the diagnosis of CD may increase a patient's susceptibility to other autoimmune diseases, such as diabetes, and/or to complications of gluten-sensitive enteropathy, such as intestinal lymphoma (5,6,9,11,19,20).…”

mentioning

confidence: 99%

Celiac Disease and Immunoglobulin A Deficiency: How Effective Are the Serological Methods of Diagnosis?

Kumar

Jarzabek-Chorzelska

Sulej

et al. 2002

Clin Vaccine Immunol

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Immunoglobulin A (IgA) deficiency is 10 to 15 times more common in patients with celiac disease (CD) than in healthy subjects. Serological tests have become the preferred methods of diagnosing CD in both symptomatic and asymptomatic patients. However, commercially available serological methods are limited in that they detect only the IgA isotype of antibodies (with the exception of IgG gliadin assays); hence, IgA-deficient patients with CD may yield false-negative serology. Fifteen pediatric patients with CD and 10 IgA-deficient pediatric patients without CD were examined for IgA and IgG antibodies to endomysium, gliadin, and tissue transglutaminase. Twenty-five specimens from patients with IgA deficiency were examined. Fifteen were from patients with CD, and 10 were patients without CD. All 15 IgA-deficient patients with CD were positive for endomysium antibodies of the IgG isotype and for IgG gliadin antibodies. All but one of the IgA-deficient patients with CD were also positive for IgG tissue transglutaminase antibodies. None of the IgA-deficient patients without CD were positive for any of the antibody markers. All the specimens examined were also negative for IgA-specific antibodies to endomysium, gliadin, and tissue transglutaminase. IgG-specific antibody tests for endomysium, gliadin, and tissue transglutaminase are useful for the identification of IgA-deficient patients with CD. IgG antibody tests along with tests routinely being used in clinical laboratories can reliably detect all active patients with CD. In addition, the levels of these CD-specific IgG antibodies could be used to monitor patient dietary compliance

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“…Reduced duodenal folds, scalloping of fold margins, mosaic pattern of mucosa and grooves in the mucosa are usual conventional endoscopic signs for celiac disease [50][51][52][53][54] . However these findings are not reliable in patchy [55,56] or milder cases of subtotal atrophy [57] . Overall, the sensitivity, specificity, positive predictive value and negative predictive value for villous atrophy on NBI are 100%, 91%, 83% and 100% respectively [58] .…”

Section: Celiac Diseasementioning

confidence: 90%

Narrow band imaging with magnification for the diagnosis of lesions in the upper gastrointestinal tract

Singh

Hussain

Loong

2013

WJGE

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Endoscopy plays an important role in the diagnosis and management of gastrointestinal (GI) tract disorders. Chromoendoscopy has proven to be superior to white light endoscopy for early detection of various GI lesions. This has however been fraught with problems. The use of color stains, time taken to achieve an effect and the learning curve associated with the technique has been some of the pitfalls. Narrow band imaging (NBI) particularly in combination with magnifying endoscopy may allow the endoscopist to accomplish a fairly accurate diagnosis with good histological correlation similar to results achieved with chromoendoscopy. Such enhanced detection of pre-malignant and early neoplastic lesions in the gastrointestinal tract should allow better targeting of biopsies and could ultimately prove to be cost effective. Various studies have been done demonstrating the utility of this novel technology. This article will review the impact of NBI in the diagnosis of upper gastrointestinal tract disorders.

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Disappointing sensitivity of endoscopic markers for villous atrophy in a high-risk population: implications for celiac disease diagnosis during routine endoscopy

Cited by 103 publications

References 16 publications

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

Celiac Disease and Immunoglobulin A Deficiency: How Effective Are the Serological Methods of Diagnosis?

Narrow band imaging with magnification for the diagnosis of lesions in the upper gastrointestinal tract

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