Not everything is celiac disease

Hassall, Eric

doi:10.1016/j.gie.2010.02.030

Cited by 6 publications

(2 citation statements)

References 18 publications

(21 reference statements)

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“…). The finding of the villous atrophy and increased intraepithelial lymphocytes alone does not always amount to the diagnosis of CD and hence the diagnosis of CD in our cohort children may be called into question. Various conditions other than CD have been shown to cause inflammatory cell infiltrates with or without villous atrophy of the duodenal mucosa and these include cow's milk or soy milk enteritis, post‐viral enteritis, Crohn's disease, immunodeficiency disorders, auto‐immune enteropathy, giardiasis, non‐steroidal anti‐inflammatory agents, Helicobacter pylori gastritis and others . However, none of our group had clinical or other histological features suggestive of these diagnoses.…”

Section: Discussionmentioning

confidence: 64%

Duodenal bulb biopsy in children for the diagnosis of coeliac disease: Experience from Perth, Australia

Sharma

Mews

Jevon

et al. 2013

J Paediatrics Child Health

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Section: Discussionmentioning

confidence: 64%

Duodenal bulb biopsy in children for the diagnosis of coeliac disease: Experience from Perth, Australia

Sharma

Mews

Jevon

et al. 2013

J Paediatrics Child Health

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“…The diagnosis of CD in this study was based strictly on histopathologic findings, and reliance on histology alone has been criticized for its lack of specificity. 27 For this reason, we considered only the most severe histopathologic changes (Marsh III lesions) as CD, excluding the increasingly common report of increased intraepithelial lymphocytosis, so as to maximize the specificity of the outcome in this analysis. Certain providers may have a particular interest or expertise in CD, and thus are more likely to submit ≥4 specimens.…”

Section: Discussionmentioning

confidence: 99%

Adherence to biopsy guidelines increases celiac disease diagnosis

Lebwohl

Kapel

Neugut

et al. 2011

Gastrointestinal Endoscopy

172

120

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Background Celiac disease (CD) is common but under-diagnosed in the United States (US). A proposed quality guideline recommends that ≥4 specimens be submitted during duodenal biopsy. Adherence to this recommendation in clinical practice is unknown. Objectives To measure the number of specimens submitted during duodenal biopsy among patients throughout the U.S., and to determine the incremental diagnostic yield of adherence to the recommended number of specimens. Design Retrospective cohort study. Methods 132,352 patients without known CD underwent duodenal biopsy submitted to a pathology laboratory operating in 43 states in the U.S. We used multivariate logistic regression to identify factors associated with submitting ≥4 specimens. We also compared prevalence of newly diagnosed CD in biopsies with ≥4 specimens to <4 specimens. Results Of the 132,352 patients who underwent biopsy (67% female, mean age 52.9), ≥4 specimens were submitted in 45,995 (35%). A modest increase in the proportion of biopsies with ≥4 specimens occurred after this guideline was proposed in 2006 (OR for 2009 vs. 2006 1.51 95%CI 1.22–1.88), but the rate of adherence in 2009 remained low at 37%. Among patients in whom the indication was malabsorption/suspected CD (n=3,261), adherence to this standard was only 39.5%. The probability of a new diagnosis of CD was increased when ≥4 specimens were submitted (1.8% vs. 0.7%, p<0.0001). Limitations Retrospective analysis lacking clinical follow-up. Guideline publication occurred during the study period, possibly influencing clinical practice and confounding results. Conclusions Although this proposed standard remains a subject of debate, adherence to submitting ≥4 specimens is low in the U.S. Adherence yields a diagnosis rate of 1.8%, a small absolute increase, but a doubling of the diagnosis rate of CD. Efforts to increase adherence are warranted.

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