Celiac.com 02/24/2010 - Proper clinical diagnosis of celiac disease
still relies on confirmation of histological evidence of villous
atrophy via biopsy. Getting a good sample can sometimes be tricky. If
histological sections are not optimally oriented, then diagnosis may be
more difficult. As a result, doctors can sometimes fail to confirm the
A team of researchers recently set out to
study the viability of confirming histological evidence of villous
atrophy in real time, during upper gastrointestinal endoscopy, in live
duodenal mucosa of patients with celiac disease, using endocytoscopy, a
novel diagnostic technique allowing in vivo real-time visualization of
mucosa under 450x magnification.
The research team included T.
Matysiak-Budnik, E. Coron1, J.-F. Mosnier, M. Le Rhun1, H. Inoue,
and J.-P. Galmiche. They are associated variously with the Institut
des Maladies de l'Appareil Digestif - INSERM U913, CIC 04 et Service
d'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, France, the
Service d'Anatomie Pathologique, E.A. Biometadys, CHU de Nantes,
France, and the Digestive Disease Center, Showa University Northern
Yokohama Hospital, Japan
The team studied sixteen subjects with
clinically proven celiac disease, together with seven controls subjects
with no celiac disease. They took endocytoscopic images from multiple
areas and then made a blind comparison against standard histology.
Endocytoscopy revealed three distinct patterns of in vivo histology.
in all controls and eight celiac disease patients (n = 15),
endocytoscopy revealed the presence of normal-appearing, long, thin
villi, lined with clearly distinguishable surface epithelial cells,
considered to be normal duodenal mucosa.
Second, in four celiac
disease patients, endocytoscopy revealed the presence of thick,
shortened villi, reflecting partial villous atrophy.
in four celiac disease patients, endocytoscopy revealed the total
absence of villi, along with the presence of enlarged crypt orifices,
reflecting total villous atrophy.
The team found solid agreement between endocytoscopy and standard histology in all 16 patients with celiac disease.
their results, they conclude that endocytoscopy permits live,
real-time, noninvasive imaging and assessment of villous architecture,
and looks to be a promising method for in vivo evaluation of duodenal
mucosa in celiac disease.Source:Endoscopy: DOI: 10.1055/s-0029-12438