How Patchy Is Patchy Villous Atrophy? Distribution Pattern of Histological Lesions in the Duodenum of Children With Celiac Disease

Ravelli, A; Villanacci, Vincenzo; Monfredini, Chiara; Martinazzi, S.; Grassi, Veronica; Manenti, Stefania

doi:10.1038/ajg.2010.153

Cited by 165 publications

(85 citation statements)

References 24 publications

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“…Allergic colitis may mimic UC particularly in infants, but also in children beyond infancy (95). Eosinophilic gastroenteritis after infancy may mimic CD with ulcerations, skip lesions reaching from the stomach to the colon and, unlike its infantile counterpart, is uncommonly associated with allergy (96).…”

Section: Allergic Disordersmentioning

confidence: 99%

ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents

Levine

Koletzko

Turner

et al. 2014

J. pediatr. gastroenterol. nutr.

1,054

787

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Background: The diagnosis of pediatric-onset inflammatory bowel disease (PIBD) can be challenging in choosing the most informative diagnostic tests and correctly classifying PIBD into its different subtypes. Recent advances in our understanding of the natural history and phenotype of PIBD, increasing availability of serological and fecal biomarkers, and the emergence of novel endoscopic and imaging technologies taken together have made the previous Porto criteria for the diagnosis of PIBD obsolete. Methods: We aimed to revise the original Porto criteria using an evidencebased approach and consensus process to yield specific practice recommendations for the diagnosis of PIBD. These revised criteria are based on the Paris classification of PIBD and the original Porto criteria while

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Section: Allergic Disordersmentioning

confidence: 99%

ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents

Levine

Koletzko

Turner

et al. 2014

J. pediatr. gastroenterol. nutr.

1,054

787

View full text Add to dashboard Cite

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“…16 In addition, diagnostic studies rely on multiple duodenal biopsies, as villous atrophy can be patchy; yet clinical practice regarding the number of biopsies is not uniform. 19,20 Consequently, local differences in practice may explain discrepancies between near-neighbor probability estimates and those derived from published studies. Furthermore, near-neighbor analysis reports continuous likelihood where most published studies use only binary cutoffs, so the greatest discrepancies are often near cutoff values.…”

Section: Discussionmentioning

confidence: 99%

Using Patients Like My Patient for Clinical Decision Support: Institution-Specific Probability of Celiac Disease Diagnosis Using Simplified Near-Neighbor Classification

2013

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“…The abnormal histological features of the small intestine observed in celiac disease may show variable severity and could be patchy with signs of injury only in certain parts of the small intestine [19]. Therefore, during upper endoscopy it is recommended to collect at least one bulb biopsy and four biopsies from the more distal part of duodenum [14] and some clinicians are encouraged to avoid collecting bulb biopsies due to that the presence of Brunner´s glands can complicate the pathological evaluation [20].…”

Section: Discussionmentioning

confidence: 99%

Validity of histology for the diagnosis of paediatric coeliac disease: a Swedish multicentre study

Montén

Bjelkenkrantz²,

Gudjonsdottir

et al. 2015

Scandinavian Journal of Gastroenterology

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Validity of histology for the diagnosis of paediatric coeliac disease: a Swedish multicentre study.Montén, Caroline; Bjelkenkrantz, Kaj; Gudjonsdottir, Audur H; Browaldh, Lars; Arnell, Henrik; Naluai, Åsa Torinsson; Agardh, Daniel Link to publication Citation for published version (APA): Montén, C., Bjelkenkrantz, K., Gudjonsdottir, A. H., Browaldh, L., Arnell, H., Naluai, Å. T., & Agardh, D. (2016). Validity of histology for the diagnosis of paediatric coeliac disease: a Swedish multicentre study. Scandinavian Journal of Gastroenterology, 51(4), 427-433. DOI: 10.3109/00365521.2015.1101486 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal AbstractObjective: Histological evaluation of intestinal biopsies for the diagnosis of celiac disease can be challenging and compatible with risk for misdiagnosis. The aim was to evaluate the agreement of pathological diagnosis for celiac disease in children investigated at four major pediatric university hospitals in Sweden. Material and Methods:Intestinal duodenal biopsies were collected from 402 children at median 9.7 years (1.4-18.3 years). A pathologist at each hospital performed the primary evaluation. A designated pathologist, blinded to the primary evaluation, performed a second Marsh classification of biopsies (M0 to M3c) taken from the bulb and duodenum separately.Kappa (κ) scores between first and second evaluation determined the agreement. Plasma samples were collected at the day of intestinal biopsy and analyzed for tissue transglutaminase autoantibodies (tTGA) using radio ligand binding assays. Results:Marsh scores were concordant in 229/356 biopsies (64%, κ=0.52, p<0.0001). Among discordant results, 15/127 (12%) showed M0 in distal duodenum but ≥M2 in the bulb, whereas the opposite was true for 8/127 (6%) of the biopsies. There were fewer collected duodenal biopsies, more missing bulb biopsies and missing CD3 staining among discordant evaluations. The second evaluation revealed a Marsh score compliant with celiac disease in 22 children of whom 7 children were tTGA positive. Conclusions:The variation between university hospitals on the pathological evaluation of biopsies may lead to misdiagnosis of celiac disease in pediatric patients. Access to clinical and endoscopic information as well as tTGA levels may be useful for the pathologist to complement the evaluation in dubious cases.

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How Patchy Is Patchy Villous Atrophy? Distribution Pattern of Histological Lesions in the Duodenum of Children With Celiac Disease

Cited by 165 publications

References 24 publications

ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents

ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents

Using Patients Like My Patient for Clinical Decision Support: Institution-Specific Probability of Celiac Disease Diagnosis Using Simplified Near-Neighbor Classification

Validity of histology for the diagnosis of paediatric coeliac disease: a Swedish multicentre study

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