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Reevaluation of Duodenal Endoscopic Markers in the Diagnosis of Celiac Disease
In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I foundedÂ The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.View all articles by Scott Adams
Bardella MT, Minoli G, Radaelli F, Quatrini M, Bianchi PA, Conte D Gastrointest Endosc. 2000 Jun;51(6):714-716
Background: Loss or reduction of duodenal folds, scalloping of Kerkring folds and a micronodular or mosaic duodenal mucosal pattern have been described in celiac disease (celiac disease), endoscopic findings that are considered reliable in the diagnosis of this disorder. However, most data have been obtained in patients with suspected or certain disease. We assessed the accuracy of the above markers in diagnosing celiac disease in patients with non-ulcer dyspepsia. Methods: In this prospective study, in 705 consecutive dyspeptic patients (284 men, 421 women, mean age 51 +/- SD 15.8 years) duodenal biopsies were obtained only in the presence of typical endoscopic markers, whereas in another 517 (207 men, 310 women, mean age 49.9 +/- SD 16 years) duodenal biopsies were done irrespective of macroscopic findings. celiac disease was diagnosed histologically and on the basis of positive antiendomysium antibody.
Results: Endoscopic markers were found in 4 patients of the first group but celiac disease was ruled out. In the second group 5 patients had an endoscopic pattern that was consistent and celiac disease was diagnosed in 3, whereas 3 others with normal endoscopic findings were eventually diagnosed as having celiac disease. Endoscopic markers had a sensitivity of 50% and a specificity of 99.6% (95% CI [11.8, 88.2 and 98.6, 99.9], respectively) with positive and negative predictive values of 60% and 99.4%, respectively.
Conclusion: The accuracy of endoscopic markers in the diagnosis of celiac disease must be reevaluated in relation to the characteristics of the population studied.
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