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Found 14 results

  1. Celiac.com 06/19/2017 - Adults with celiac disease often show atypical symptoms, though it is not uncommon for them to suffer from malabsorption of vitamins and minerals, which can result in disrupt normal bone metabolism. A team of researchers recently set out to evaluate laboratory deficiencies related to bone metabolism, and to assess the relationship between severity of histological damage and the degree of bone mass loss at celiac diagnosis. The research team included L. Posthumus, and A. Al-Toma A of the Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands. Their team conducted a retrospective cross-sectional study of 176 adult celiac patients. All patients met the histopathological criteria for clinical celiac disease. The team analyzed biochemical data, including calcium, phosphate, alkaline-phosphatase, vitamin D and parathormone. They classified duodenal histology based on Marsh parameters. They used dual X-ray absorptiometry to determine bone mass density (BMD) at the lumbar and femoral regions. P-values below 0.05 were considered significant. They found no correlation between gastrointestinal symptoms and Marsh histopathological stage (P>0.05). Nearly 50 percent of patients showed vitamin D deficiency (44.5%), while only 5.7% showed hypocalcaemia. Patients with Marsh III did show lower calcium (P<0.05) and parathormone was higher (P=0.01). These patients had lower lumbar T-score (P<0.05). Although low BMD occurred in all age groups, most osteoporotic patients were aged 45-49 years (81.8%). A multiple regression analysis did show that Marsh stage could indicate lower lumbar BMD (r=0.322, B=-1.146, P<0.05). At celiac diagnosis, Marsh histopathological stage can predict low BMD, which can develop into osteoporosis. Based on these data, the team suggests that doctors should consider evaluating bone biomarkers and conducting a dual X-ray absorptiometry exam in celiac patients over 30 years of age. Source: Eur J Gastroenterol Hepatol. 2017 Apr 27. doi: 10.1097/MEG.0000000000000880.
  2. Celiac.com 08/01/2016 - Symptoms and damage in celiac disease is caused by partially-degraded gluten peptides from wheat, barley and rye. Susceptibility genes are necessary to trigger celiac disease, but they can't do it alone. Some researchers suspect that these susceptibility genes might get help from conditions resulting from unfavorable changes in the microbiota. To better understand the whole picture, a team of researchers recently set out to examine gluten metabolism by opportunistic pathogens and commensal duodenal bacteria, and to characterize the ability of the resulting peptides to activate gluten-specific T-cells from celiac patients. The research team included A Caminero, HJ Galipeau, JL McCarville, CW Johnston, S Bernier, AK Russell, J Jury, AR Herran, J Casqueiro, JA Tye-Din, MG Surette, NA Magarvey, D Schuppan, and EF Verdu. They are variously affiliated with the Farncombe Family Digestive Health Research Institute, and the Department of Biochemistry & Biomedical Sciences, M. G. DeGroote Institute for Infectious Disease Research at McMaster University, Hamilton, Ontario, Canada; the Immunology Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria, Australia; the Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia; Área de Microbiología, Facultad de Biología y Ciencias Ambientales, Universidad de León, León, 24071 Spain; the Immunology Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria, 3052 Australia; the Department of Gastroenterology, The Royal Melbourne Hospital, Grattan St., Parkville, Victoria, 3050 Australia, and the Institute for Translational Immunology and Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany. For their study, the team colonized germ-free C57BL/6 mice with bacteria isolated from the small intestine of celiac patients or healthy controls, selected by their in vitro gluten-degrading capacity. They then measured gliadin levels and proteolytic action in intestinal contents after gluten feeding. Using peripheral blood mononuclear cells from celiac patients after receiving a 3-day gluten challenge, the research team characterized by LC-MS/MS the eptides produced by bacteria used in mouse colonizations from the immunogenic 33-mer gluten peptide. They found that the bacterial colonizations created clear gluten degradation patterns in the small intestine of the mice. Pseudomonas aeruginosa (Psa), an opportunistic pathogen from celiac patients, exhibited elastase activity and produced peptides that better translocated the mouse intestinal barrier. Psa-modified gluten peptides activated gluten-specific T-cells from celiac patients. In contrast, Lactobacillus spp. from the duodenum of non-celiac controls degraded gluten peptides produced by human and Psa proteases, reducing their immunogenicity. From these data, the research team concludes that small intestinal bacteria show clear gluten metabolic patterns in vivo, increasing or reducing gluten peptide immunogenicity. This microbe-gluten-host interaction may modulate autoimmune risk in genetically susceptible persons and may underlie any connection between celiac disease and microbial imbalance or maladaptation in the digestive tract. Source: Gastroenterology. 2016 Jun 30. pii: S0016-5085(16)34713-8. doi: 10.1053/j.gastro.2016.06.041.
  3. Celiac.com 06/15/2016 - Every so often, a medical case comes along that puzzles or interests clinicians. One recent case of celiac disease fits that bill. The patient in this case is a 61-year-old obese woman who developed severe diarrhea that started soon after bariatric surgery and did not respond to standard medical treatment. The team treating the woman reports that, to their knowledge, this is the first reported case of clinical onset of celiac disease (celiac disease) following duodenal switch surgery. The research team included A Pané, A Orois, M Careaga, A Saco, E Ortega, J Vidal, P Leyes, and AJ Amor. They are variously affiliated with the Department of Endocrinology and Nutrition, and the Department of Anatomic Pathology at the Hospital Clínic in Barcelona, Spain. After the team ruled out the most common post-operative causes of diarrhea, they ran some blood tests, and made a final diagnosis based on positive results for anti-tissue transglutaminase antibody. In light of this case report, the team proposes that celiac disease should be ruled out in any patient presenting with typical or atypical symptoms after bariatric surgery, regardless of the latency of onset. Read more on this case in the Eur J Clin Nutr. 2016 Apr 20. doi: 10.1038/ejcn.2016.65.
  4. Celiac.com 09/15/2014 - Duodenal intraepithelial lymphocytosis (D-IEL) is an early marker for celiac disease, even though a majority of cases are due to non-celiac disease conditions. Researchers I. Aziz, T. Key, J.G. Goodwin, and D.S. Sanders wanted to identify the predictors of celiac disease in patients presenting with D-IEL. For their study, they reviewed 215 adults with D-IEL who had undergone prospective and systematic evaluation for celiac disease and other recognized associations. They confirmed celiac disease based on presence of HLA-DQ2 and/or DQ8, persistence or progression of D-IEL following a gluten challenge, and an improvement in symptoms with a gluten-free diet. To compare factors in celiac and non-celiac cases, and to determine their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), the team used binary logistic regression models, adjusted for age and sex. They diagnosed celiac disease in 48 cases (22%) and non-celiac in 167 cases (78%). They found no statistical difference between the celiac and non-celiac group in terms of baseline demographics, anemia, hematinics, or clinical symptoms, such as diarrhea, weight loss, abdominal pain. Compared with their non-celiac counterparts, celiac patients were significantly more likely to have a positive family history of celiac disease (21% vs. 3.6%, OR 6.73; PPV 62.5%, NPV 81%, specificity 96.4%), positive HLA-DQ status (100% vs. 49.1%; PPV 36.4%, NPV 100%, specificity 50.9%), and presence of endomysial antibody (EMA) (48% vs. 0%; PPV 100%, NPV 87%, specificity 100%); all P≤0.001. A total of 29.2% celiac and 83.2% non-celiac cases showed normal tissue transglutaminase antibody (TTG) levels (OR 0.084, P<0.001; PPV 9.2%). Between the groups, there was no difference in the prevalence of TTG levels 1 to 2×upper limit of normal (29.2% celiac vs. 14.4% non-celiac; PPV 33% to 38%). However, TTG levels between 3 and 20×ULN were much more common in the celiac group (33.3% vs. 2.4%, PPV 66.6% to 89%), whereas a TTG>20×ULN was exclusive to celiac disease (8.3%, P<0.001, PPV 100%). For patients with D-IEL, only a positive EMA or TTG greater than 20×ULN at the outset can yield an immediate celiac diagnosis. On their own, factors such as gastrointestinal symptoms, family history, anemia, or other celiac serology results do not reliably distinguish celiac from non-celiac patients. Source: J Clin Gastroenterol. 2014 Jul 10.
  5. Celiac.com 08/19/2013 - Data from blood studies suggest that about 1% or so of North Americans have celiac disease. However, there is no good screening data based on small intestinal biopsy performed during routine endoscopic evaluations. Researcher H.J Freeman recently set out to determine rates of detection of adult celiac disease via duodenal screening biopsies over a thirty year period. For his study, he looked at patients referred between January 1982 and December 2011 for evaluation of gastrointestinal symptoms that required elective investigative upper endoscopic assessment, and who underwent duodenal biopsies to determine whether changes of adult celiac disease were present. Freeman looked at a total of 9665 patients, including 4008 (41.5%) males and 5657 (68.5%) females, who underwent elective endoscopies and duodenal biopsies. Overall, 234 patients (2.4%) exhibited changes of celiac disease. That included 73 males (1.8%) and 161 females (2.8%). During the first 20 years, the number of biopsy-positive patients in five-year intervals progressively decreased, while, during the next 10 years, the number progressively increased. From this study, the team concludes that celiac disease is far more common in specialist practice than has been suggested in the evaluation of healthy populations using serological screening studies. Endoscopic duodenal biopsy is an important way to spot underlying celiac disease and should be routinely considered in all patients undergoing an elective endoscopic evaluation. They also note that the appearance of biopsy-defined celiac disease may be influenced by non-inherited factors, possibly environmental, which alter its detection over time. Source: Can J Gastroenterol. 2013 Jul;27(7):405-8.
  6. Celiac.com 07/12/2012 - A research team affiliated with the Department of Endocrinology and Nutrition at Complejo Hospitalario Mancha Centro in Alcázar de San Juan, Spain, recently set out to study how bone mineral density correlates with duodenal Marsh stage in newly diagnosed adult celiac patients. The team made up of A. García-Manzanares, J.M. Tenias, and A.J. Lucendo. For their study, the researchers wanted to estimate the rates of low bone mineral density (BMD) in adult celiac patients and to better understand nutritional and metabolic factors associated with osteoporosis and osteopenia. To do so, they recruited patients a consecutive group of 40 adults (36 females/4 males), between the ages of 18 and 68, who were newly diagnosed with celiac disease. Average patient age was 44.25 years. For each patient, the researchers conducted bone density scans on the left hip and lumbar spine using dual-energy X-ray absorptiometry. They also assessed nutritional parameters and conducted a hormone study to exclude secondary low BMD. Overall, at diagnosis 45% of patients showed low BMD at both hip and lumbar spine. Risk of hip fracture was generally low, but climbed into the mild range for patients with villous atrophy (p = 0.011). The team also found that major fracture risk varied according to Marsh stage (p = 0.015). They found significant differences in nutritional status between patients with and without duodenal villous atrophy. Marsh III stage patients showed substantially reduced body mass index and blood levels of pre-albumin, iron, vitamin D and folic acid. The team found no differences found in blood hormone levels between Marsh stages or BMDs. They found that the amount of bone mass loss in the lumbar spine was directly tied to Marsh stage. They found a parallel association between BMD and Marsh stage in the hip, but this was not statistically significant. Overall, results showed that duodenal villous atrophy, through malabsorption, was the main factor for low BMD in patients with adult-onset celiac disease. Source: Scand J Gastroenterol. 2012 May 16.
  7. Celiac.com 05/21/2012 - A trio of researchers recently compared duodenal and jejunal small intestinal biopsies for diagnosis and follow-up of celiac disease. The researchers included J.W. Meijer, P.J. Wahab, and C.J. Mulder from the Department of Pathology, Rijnstate Hospital Arnhem, The Netherlands. Current pediatric guidelines advise doctors to take intestinal mucosal specimens from the jejunum using a suction capsule. This method can be stressful for patients, time-consuming, expensive and requires the use of imaging technology. Taking mucosal biopsies from the distal duodenum using forceps is less stressful for patients, easier, cheaper and can be done using an endoscope. For those reasons, the researchers wanted to compare the histological results of biopsies taken from the duodenal mucosa by forceps and from the jejunal mucosa using suction capsule. To do so, they evaluated 171 paired biopsies taken from 109 patients from 1 to 75 years of age. Biopsies were made from the distal duodenal mucosa using jumbo forceps and from the jejunal mucosa using Crosby suction capsule. For histological interpretation they applied modified Marsh classification, including partial-, subtotal and total villous atrophy as Marsh IIIA, B, and C. A total of fourteen (8%) of the suction capsule biopsies were too low quality to be properly scored, while all duodenal biopsies taken with forceps produced adequate material for histological scoring. Of the remaining biopsies, a total of 145 of 157 (92%) showed no difference in histological scores. The remaining 12 biopsies showed some discrepancy in scoring, four of those showed more severe lesions in the duodenum, while eight showed more severe lesions in the jejunum. The differences were clinically significant, and included the presence and absence of villous atrophy in nine of the 157 paired biopsies (6%). The results showed that mucosal specimens taken from the distal duodenal and jejunal mucosa are strongly correlated, with clinically significant discrepancies were present in only 6% of paired biopsies. Based on these results, the researchers suggest that diagnosis and follow-up of celiac disease can be done using mucosal specimens taken from the duodenum using forceps, rather than the traditional biopsy of the jejeunum using Crosby suction capsule. Source: Virchows Arch. 2003 Feb;442(2):124-8. Epub 2002 Dec 20.
  8. Celiac.com 09/23/2011 - Despite the current sensitivity and specificity of blood tests, a small bowel biopsy showing villous atrophy remains the international gold standard for diagnosing celiac disease. Yet the small intestine is actually quite long, and villous atrophy can be dispersed throughout and therefore potentially missed, especially in children. Experts recommend that at least four tissue samples be taken to circumvent this problem, but have not specified the optimal sites from which to take the samples. Jejunal biopsies have historically been performed, but they are uncomfortable for the patient and technically complicated. Duodenal biopsies are safer and easier, and there is even some data suggesting that the duodenal bulb may be the only site of villous atrophy in patients newly diagnosed with celiac disease. Yet it was not known whether biopsy of the duodenal bulb alone would be sufficient to identify established celiac disease in adult patients. A recent study aimed to compare histology of the duodenal bulb in adults with newly diagnosed celiac disease, established celiac disease, and no celiac disease. They found that villous atrophy may in fact only be present in the duodenal bulb, and that this is therefore the optimal site for biopsy in diagnosing celiac disease. Four hundred and sixty-one patients were analyzed, with a mean age of 51 years. They were recruited from a hospital in the United Kingdom between November 2008 and July 2010. Three hundred were women and one hundred and sixty-one were men. One hundred and twenty-six were newly diagnosed with celiac disease; eighty-five had established celiac disease, had been adhering to a gluten free diet, and were undergoing biopsy to histologically assess their remission; and two hundred and fifty were healthy controls. Five biopsies were taken from each patient: one from the duodenal bulb and four from the second part of the duodenum, one from each quadrant. Twenty-three patients exhibited villous atrophy only in the duodenal bulb, and both new and established celiac cases were significantly more likely to exhibit this phenomenon than controls. Most of the patients with lesions of varying severity at different locations had the more severe lesion in the duodenal bulb. Similar results have been achieved with children in other studies. The researchers note that their results are support and are supported by the literature, and conclude that "the optimal strategy for diagnosing celiac disease could only achieve 100% sensitivity by always incorporating a duodenal bulb biopsy." Source: Evans KE, Aziz I, Cross SS, Sahota GR, Hopper AD, Hadjivassiliou M, Sanders DS. A Prospective Study of Duodenal Bulb Biopsy in Newly Diagnosed and Established Adult Celiac Disease. Am J Gastroenterol. 2011 May 24.
  9. Celiac.com 02/24/2010 - Proper clinical diagnosis of celiac diseasestill relies on confirmation of histological evidence of villousatrophy via biopsy. Getting a good sample can sometimes be tricky. Ifhistological sections are not optimally oriented, then diagnosis may bemore difficult. As a result, doctors can sometimes fail to confirm theproper diagnosis. A team of researchers recently set out tostudy the viability of confirming histological evidence of villousatrophy in real time, during upper gastrointestinal endoscopy, in liveduodenal mucosa of patients with celiac disease, using endocytoscopy, anovel diagnostic technique allowing in vivo real-time visualization ofmucosa 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 Institutdes Maladies de l'Appareil Digestif - INSERM U913, CIC 04 et Serviced'Hépato-Gastroentérologie, Hôtel Dieu, CHU de Nantes, France, theService d'Anatomie Pathologique, E.A. Biometadys, CHU de Nantes,France, and the Digestive Disease Center, Showa University NorthernYokohama Hospital, Japan The team studied sixteen subjects withclinically proven celiac disease, together with seven controls subjectswith no celiac disease. They took endocytoscopic images from multipleareas and then made a blind comparison against standard histology. Endocytoscopy revealed three distinct patterns of in vivo histology. First,in all controls and eight celiac disease patients (n = 15),endocytoscopy revealed the presence of normal-appearing, long, thinvilli, lined with clearly distinguishable surface epithelial cells,considered to be normal duodenal mucosa. Second, in four celiacdisease patients, endocytoscopy revealed the presence of thick,shortened villi, reflecting partial villous atrophy. Finally,in four celiac disease patients, endocytoscopy revealed the totalabsence 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. Fromtheir 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 duodenalmucosa in celiac disease. Source: Endoscopy: DOI: 10.1055/s-0029-12438
  10. Celiac.com 06/23/2009 - Fibroblasts are one of the most important components in inflammation and tissue remodeling process, and are thought to be involved in the pathogenesis of autoimmune disorders such as celiac disease. Attempts to better understand the role played by fibroblasts in celiac diseases have been hampered by the absence of specific models. A team of researchers recently set out to isolate and culture primary fibroblasts from endoscopic duodenal biopsies of celiac and non-celiac subjects, and to analyze their growth patterns and any morphometric characteristics. The research team obtained 60 tissue samples via duodenal biopsy from 20 celiac patients and 114 samples from 38 non-celiac subjects. The team then mechanically chopped and enzymatically digested in order to obtain primary cell cultures. Using cultured cells, the researchers charted growth patterns, karyotype (Q-banding analysis), expression of typing proteins (fibroblast surface protein and cytokeratin 20) and morphometric parameters (diameters and their ratio, perimeter, area and perimeter/area ratio at computerised image analysis) They were able to successfully culture primary cells in 78% of the collected duodenal biopsies. Cultured cells, expressing the fibroblast surface protein, tested negative for cytokeratine 20 and maintained a normal kariotype. Cells grew slowly with no differences between the celiac and the non-celiac group. Morphometric analysis of celiac fibroblasts showed substantially increased size, with a preserved diameters ratio, and a reduced perimeter/area ratio. For the first time, researchers have shown the feasibility of culturing primary fibroblast cells from endoscopic duodenal biopsies in celiac and non-celiac subjects. This ability shows promise for enhancing studies intended to establish the role of fibroblasts as a possible partaker in the pathogenesis of the celiac mucosal damage. Source: Journal of Translational Medicine 2009, 7:40
  11. The following abstract was submitted to celiac.com directly by William Dickey, Ph.D., a leading celiac disease researcher and gastroenterologist who practices at Altnagelvin Hospital, Londonderry, Northern Ireland. Scandinavian Journal of Gastroenterology 2005; 40: 1240-3. Dickey W, Hughes DF, McMillan SA. Celiac.com 09/27/2005 - What does a positive endomysial antibody (EmA) test mean if the biopsy does not show villous atrophy? The authors studied 35 patients where this was the case. In the authors practice, these patients account for 10% of all EmA positives. Firstly, the lack of villous atrophy did not necessarily mean a normal biopsy: 14 patients had excess inflammatory cells (lymphocytes) consistent with a mild abnormality of gluten sensitivity. Secondly, many of these patients had typical celiac features: twelve had a family history of celiac, five had dermatitis herpetiformis and thirteen had osteopenia or osteoporosis on DEXA scan. After discussion, 27 patients opted to take a gluten-free diet from the first biopsy: 26 of these had clinical improvement. Seven of eight patients who persisted with a normal diet developed villous atrophy on follow-up biopsies. The authors conclude that a positive EmA result indicates gluten sensitivity even if biopsies do not show villous atrophy. While a biopsy remains important as a baseline reference, these patients should be offered a gluten-free diet to allow clinical improvement and prevent the development of villous atrophy. There may be no such thing as a "false positive" EmA, although the authors emphasise that the same conclusion cannot yet be applied to tissue transglutaminase antibody results.
  12. Scand J Gastroenterol. 2003 Aug;38(8):831-3. Celiac.com 09/29/2003 - In the following abstract the authors point out that in endoscopic screenings, adenocarcinoma is found less often than statistics from studies suggest it should be, implying that routine endoscopic examinations are not adequate to detect it. If this interpretation of the study is correct, other methods of screening for it need to be utilized or developed. Another possible way to look at this is that celiac patients do not have an elevated risk of adenocarcinoma when compared to the normal population, but given the numerous studies that have shown otherwise this possibility seems unlikely. I would also like to point out that the 60- to 80-fold increased risk of small bowel adenocarcinoma in patients with celiac disease that the author mentions is true for untreated celiacs. -Scott Adams Here is the abstract: Rampertab SD, Fleischauer A, Neugut AI, Green PH. Dept. of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, USA. BACKGROUND: There is a 60- to 80-fold increased risk of small bowel adenocarcinoma in patients with celiac disease. While the adenoma-carcinoma sequence appears to operate in the small bowel as in the large bowel, the risk of duodenal adenomas in celiac patients is unknown. METHODS: The records of 381 patients (245 F, 136 M) with biopsy-proven celiac disease were reviewed to determine the prevalence of duodenal adenoma found during esophagogastroduodenoscopy (EGD). We conducted an extensive literature review to find data for estimates of the prevalence of duodenal adenoma in a comparable general population; we used data from a study at another New York City medical center of 7,346 EGDs conducted between 1976 and 1982 (Ghazi et al., 1984). We estimated the relative risk, expressed as a standard morbidity ratio (SMR), by calculating the observed to expected (O/E) ratio. RESULTS: Duodenal adenomas were found in 3 celiac patients (0.78%), with 24 adenomas (0.33%) in the reference population, giving an SMR of 2.39 (95% CI 0.67-8.48). CONCLUSION: We did not find a significantly increased risk of duodenal adenoma in celiac patients compared to a non-celiac endoscoped population. Thus, despite the previously described elevated risk of small bowel adenocarcinoma in these patients, routine endoscopic examination of the duodenum may not be adequate for screening.
  13. Celiac.com 2/13/2003 - This new study emphasizes the importance of following a strict gluten-free diet, and getting regular follow-up biopsies after your diagnosis. It also speaks to the need to discover whether or not you may have additional food intolerance, such as to cows milk (casein), soy, corn, etc., as some of these can also cause intestinal damage similar to that of celiac disease. -Scott Adams Lee SK, Lo W, Memeo L, Rotterdam H, Green PH. Gastrointest Endosc 2003 Feb;57(2):187-91 Current affiliations: Department of Surgical Pathology and Medicine, Columbia University College of Physicians and Surgeons, New York, New York. BACKGROUND: The diagnosis of celiac disease requires characteristic histopathological changes in an intestinal biopsy with clinical improvement in response to a gluten-free diet. Endoscopy with procurement of biopsy specimens is often performed to document response to the diet, but there are little data on the appearance of treated celiac disease. This study examined the endoscopic and histopathological appearance of the duodenum of patients with celiac disease whose diet was gluten-free. METHODS: A cohort of 39 adult patients (mean age 52 years, range 20-74 years) with biopsy-proven celiac disease was retrospectively reviewed. All had responded clinically to a gluten-free diet that they had maintained for a mean of 8.5 years (range 1-45 years). The endoscopic and histopathological appearances of the duodenal mucosa were reviewed. Blinded review of the diagnostic (initial) and post-treatment biopsy specimens was also performed to assess response of individual patients to the diet. RESULTS: The endoscopic appearance was normal in 23%, reduced duodenal folds were present in 46%, scalloping of folds in 33%, mucosal fissures in 44%, and nodularity in 33%. There was more than 1 abnormality present in 46%. Histology was normal in only 21%. The remainder had villous atrophy (69% partial, 10% total). Paired (diagnostic and follow-up) biopsy specimens were reviewed blindly for 12 patients. The mean (SD) intraepithelial lymphocyte count fell from 61 (22) to 38 (17) (normal CONCLUSIONS: Despite a good clinical response, abnormal endoscopic and histopathological appearances persist in the majority of patients with celiac disease treated with a gluten-free diet. PMID: 12556782
  14. 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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