Upper gastrointestinal endoscopic findings in celiac disease at diagnosis: A multicenter international retrospective study

Abstract

BACKGROUND Gastroduodenal endoscopy and biopsy following positive specific serology is considered the gold standard to diagnose celiac disease (CeD) in adults. Whether upper endoscopy helps detect comorbid conditions is unknown. AIM To investigate the prevalence of non-celiac endoscopic findings in patients in whom endoscopy was performed to confirm CeD diagnosis. METHODS This is an observational, descriptive, multicenter, retrospective study that reports endoscopic findings obtained in adult patients enrolled in local registries from four tertiary centers. We collected data reported on first endoscopy, indicated for investigation of CeD. Diagnosis of CeD was performed by histology (≥ Marsh 2 type mucosal damage) and specific serology. Two European and one North American center included biopsy-confirmed CeD following positive serology. A fourth center (South America) included symptomatic patients undergoing endoscopy, irrespective of CeD serology. The latter cohort included a non-CeD control group. RESULTS A total of 1328 patients (80% female; 35 years median age) were enrolled, of whom 95.6% had positive specific serology. In 135 patients, endoscopy revealed 163 abnormalities unrelated to CeD (prevalence: 10.1%). Erosive reflux esophagitis (6.4%), gastric erosions (2.0%), and suspicion of esophageal metaplasia (1.2%) were the most common findings. Biopsy-confirmed Barrett’s esophagus was infrequent (0.2%). No endoscopic cancer was detected. Older patients (≥ 51 years of age) had a higher prevalence of endoscopic findings than those ≤ 50 ( P < 0.01). Within the South American cohort, CeD was associated with a lower rate (8.2%) of comorbid endoscopic findings compared with controls (29.1%; P < 0.001). In the adjusted multivariate analysis of this cohort, having CeD was associated with a 72% reduction in the risk of any endoscopic abnormality (P < 0.0001), and having alarm symptoms was associated with a 37% reduction in the risk of finding at least one endoscopic lesion ( P < 0.02). CONCLUSION In this large multicenter study, young adults with positive CeD serology had few comorbid endoscopic findings. Although patients over 51 years had a high prevalence of non-CeD gastroduodenal mucosal damage, no malignancy or premalignant lesions were found.

Coeliac disease is a strong risk factor for Gastro-oesophageal reflux disease while a gluten free diet is protective: a systematic review and meta-analysis

“…Gender: not reported. Anti-tissue transglutaminase AND histopathology Symptoms 5/9 no Stefanolo 2022 61 Retrospective, cross-sectional, multiple countries. Included a control group which was not analysed due to unclear definition.…”

“… 33 , 34 , 37 , 40 Our analysis of data from Stefanolo et al. 61 showed no significant difference of the prevalence of GORD in CD in those less than 50 years of age (6.1% of 1140) compared to those older (8.5% of 188, p = 0.20), and age appeared to have no influence on the prevalence of GORD in CD based on 3 studies, 33 , 34 , 57 but a pooled statistical analysis was not possible. Two studies 53 , 54 yielded conflicting results regarding duodenal histology predicting GORD symptoms, with a larger study of 549 CD cases reporting mucosal integrity, denoted by villous height/crypt depth ratio, negatively correlating with GORD symptoms (r = −0.115, p = 0.0070).…”

The debate in the diagnosis of coeliac disease – time to go ‘no-biopsy’?

“…However, some expert gastroenterologists have intimated caution over its adoption into adult guidelines and still recommend endoscopy with biopsies in suspected CD. A major consideration of omitting a biopsy is the fear of missing co-existing pathology [53]. However, recent studies do not support this [54,55] and a gastroscopy is still required -irrespective of the tTG titre -in the setting of red flag symptoms or where there is a high index of suspicion for concurrent pathology.…”