Diagnosis of Celiac Disease at Open Access Endoscopy

William Dickey Department of Gastroenterology, Altnagelvin Hospital, Londonderry, Northern Ireland, UK
Scandinavian Journal of Gastroenterology 1998; 33: 612-5.

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Abstract Background: Coeliac disease may present with dyspepsia or reflux. There are characteristic duodenal appearances associated with villous atrophy (mosaic pattern mucosa and loss, reduction in number or scalloping of duodenal folds) which may prompt small bowel biopsy during routine upper gastrointestinal endoscopy. These appearances were sought in patients referred by their general practitioners for open access endoscopy (OAE), to determine the prevalence and significance of coeliac disease as a cause of symptoms.

Methods: Five hundred consecutive patients undergoing OAE by one consultant gastroenterologist were studied. Forceps biopsies from the distal duodenum were taken if appearances were suggestive. If villous atrophy was confirmed, the response of symptoms to dietary gluten exclusion was assessed.

Results: Ten patients had suspicious endoscopic appearances of whom 8 had villous atrophy, giving a prevalence of coeliac disease of 1.6% (1:63). All 8 had mosaic pattern mucosa with three also having reduction of duodenal folds, and four having scalloped folds. All had serum endomysial antibodies (EmA). Apart from diarrhea, described by one patient, there were no symptoms of typical coeliac disease at diagnosis: three patients were overweight. After dietary gluten exclusion, all reported symptomatic improvement with disappearance of EmA in 5 patients to date.

Conclusions- There is a high prevalence of coeliac disease among patients undergoing OAE, which is relevant to their clinical symptoms and which can be identified by careful endoscopic inspection of the duodenum.