Digestive Diseases and Sciences

, Volume 58, Issue 5, pp 1293–1298 | Cite as

Prior Endoscopy in Patients with Newly Diagnosed Celiac Disease: A Missed Opportunity?

  • Benjamin Lebwohl
  • Govind Bhagat
  • Sarah Markoff
  • Suzanne K. Lewis
  • Scott Smukalla
  • Alfred I. Neugut
  • Peter H. R. Green
Original Article



Celiac disease (CD) is under-diagnosed in the United States, and factors related to the performance of endoscopy may be contributory.


To identify newly diagnosed patients with CD who had undergone a prior esophagogastroduodenoscopy (EGD) and examine factors contributing to the missed diagnosis.


We identified all patients age ≥18 years whose diagnosis of CD was made by endoscopy with biopsy at our institution (n = 316), and searched the medical record for a prior EGD. We compared those patients with a prior EGD to those with without a prior EGD with regard to age at diagnosis and gender, and enumerated the indications for EGD.


Of the 316 patients diagnosed by EGD with biopsy at our center, 17 (5 %) had previously undergone EGD. During the prior non-diagnostic EGD, a duodenal biopsy was not performed in 59 % of the patients, and ≥4 specimens (the recommended number) were submitted in only 29 % of the patients. On the diagnostic EGD, ≥4 specimens were submitted in 94 %. The mean age of diagnosis of those with missed/incident CD was 53.1 years, slightly older than those diagnosed with CD on their first EGD (46.8 years, p = 0.11). Both groups were predominantly female (missed/incident CD: 65 vs. 66 %, p = 0.94).


Among 17 CD patients who had previously undergone a non-diagnostic EGD, non-performance of duodenal biopsy during the prior EGD was the dominant feature. Routine performance of duodenal biopsy during EGD for the indications of dyspepsia and reflux may improve CD diagnosis rates.


Celiac disease Endoscopy Biopsy Diagnosis 



B.L.: The National Center for Advancing Translational Sciences, National Institutes of Health (KL2 TR000081).

Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Benjamin Lebwohl
    • 1
    • 2
  • Govind Bhagat
    • 1
    • 3
  • Sarah Markoff
    • 1
  • Suzanne K. Lewis
    • 1
  • Scott Smukalla
    • 1
  • Alfred I. Neugut
    • 2
  • Peter H. R. Green
    • 1
  1. 1.Department of Medicine, Celiac Disease Center at Columbia UniversityColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  3. 3.Department of Pathology and Cell BiologyColumbia University Medical CenterNew YorkUSA

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