Advertisement

Digestive Diseases and Sciences

, Volume 38, Issue 11, pp 2028–2033 | Cite as

Value of endoscopic markers in celiac disease

  • Eduardo Mauriño
  • Horacio Capizzano
  • Sonia Niveloni
  • Zulema Kogan
  • Jorge Valero
  • Luis Boerr
  • Julio Cesar Bai
Original Articles

Abstract

Duodenoscopy in celiac disease has identified several markers of the disease. Our aim was to evaluate, in a prospective study, the usefulness of the different endoscopic features in 100 consecutive cases referred to endoscopy for intestinal biopsy. Histological examination of duodenal samples showed severe villous atrophy (grade III/IV) in 36 patients. Of these patients, 34 had endoscopic markers suggestive of celiac disease. These were reduction in number or loss of Kerkring's folds (in 27), mosaic pattern (14), scalloped folds (12), and visibility of the underlying blood vessels (5). Endoscopic visualization of these markers had a sensitivity of 94%, a specificity of 92%, and a positive predictive value of 84%. Reduction in number, or loss of, Kerkring's folds was the most sensitive (76%) and specific (98%) single endoscopic change indicating celiac disease. Duodenoscopy permitted diagnosis in three of four asymptomatic patients in a group of 24 first-degree relatives of celiac disease patients. We conclude that endoscopy of distal duodenum is a sensitive and specific indicator of celiac disease.

Key Words

celiac disease endoscopic markers 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gillberg R, Ahren C: Celiac disease diagnosed by means of duodenoscopy and endoscopic duodenal biopsy. Scand J Gastroenterol 12:911–916, 1977Google Scholar
  2. 2.
    Holdstock G, Eade OE, Isaacson P, Smith CL: Endoscopic duodenal biopsies in celiac disease and duodenitis. Scand J Gastroenterol 14:717–720, 1979Google Scholar
  3. 3.
    Scott BB, Jenkins D: Endoscopic small intestinal biopsy. Gastrointest Endosc 27:162–167, 1981Google Scholar
  4. 4.
    McCarthy CF, Stevens FM: The endoscopic demonstration of celiac disease. Endoscopy 8:177–180, 1976Google Scholar
  5. 5.
    Schweb D, Kleinman MS, Turner MD: Endoscopic appearance of the jejunum in a patient with gluten-sensitive enteropathy and a gastrojejunostomy. Am J Dig Dis 17:430–434, 1972Google Scholar
  6. 6.
    Brocchi E, Corazza GR, Caletti G, Treggiari EA, Barbara L, Gasbarrini G: Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease. N Engl J Med 319:349–344, 1988Google Scholar
  7. 7.
    Jabbari M, Wild G, Goresky CA, Daly DS, Lough JO, Cleland P, Kinear DG: Scalloped valvulae conniventes: An endoscopic marker of celiac disease. Gastroenterology 95:1518–1522, 1988Google Scholar
  8. 8.
    Ng DPK, McIntyre AS, Smith J, Anoah J, Long RG: Reduction of duodenal folds seen at endoscopy is predictive of celiac disease. Gastrointest Endosc 38:148–151, 1992Google Scholar
  9. 9.
    Corazza GR, Caletti G, Brocchi E, Gasbarrini G: Kerkring's duodenal folds in celiac disease. Gastroenterology 97:1064–1065, 1989 (letter)Google Scholar
  10. 10.
    Jabbari M, Wild G, Goresky C: Letter. Gastroenterology 97:1064–1065, 1989Google Scholar
  11. 11.
    Barkin JS, Schonfelt W, Thomsen S, Mantan HD, Rogers AL: Enteroscopy and small bowel biopsy—an improved technique for the diagnosis of small bowel disease. Gastrointest Endosc 31:215–217, 1985Google Scholar
  12. 12.
    Bai JC, Sambuelli A, Niveloni S, Sugai E, Mazure R, Kogan Z, Pedreira S, Boerr L: Alpha-1-antitrypsin clearance as an aid in the management of patients with celiac disease. Am J Gastroenterol 86:986–991, 1991Google Scholar
  13. 13.
    Bai JC, Sambuelli A, Sugai E, Pedreira S, Boerr LA, Martinez C, Maurino E: Gluten challenge in patients with celiac disease: Evaluation of alpha-1-antitrypsin clearance. Am J Gastroenterol 86:312–316, 1991Google Scholar
  14. 14.
    Foster PN, Mitchell CJ, Robertson DRC: Prospective comparison of three non-invasive tests for pancreatic disease. Br Med J 289:13–16, 1984Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Eduardo Mauriño
    • 1
  • Horacio Capizzano
    • 1
  • Sonia Niveloni
    • 1
  • Zulema Kogan
    • 1
  • Jorge Valero
    • 1
  • Luis Boerr
    • 1
  • Julio Cesar Bai
    • 1
  1. 1.Section of Small Bowel Diseases, Service of EndoscopyHospital Nacional de Gastroenterologia “C. Bonorino Udaondo”Buenos AiresArgentina

Personalised recommendations