Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption

Siegel, Lance M.; Stevens, Peter D.; Lightdale, Charles J.; Green, Peter H.R.; Goodman, Stephen I.; Garcia-Carrasquillo, Reuben J.; Rotterdam, Heidrun

doi:10.1016/s0016-5107(97)70091-9

Cited by 107 publications

(43 citation statements)

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“…The extent of duodenal intraepithelial lymphocytosis is also not helpful in making the distinction between celiac disease and other small bowel diseases with increased intraepithelial lymphocytes. 13 Intraepithelial lymphocyte expansions in celiac disease can occasionally be patchy [31][32][33] that is, only one or a few biopsy pieces have increased intraepithelial lymphocytes. A top heavy or villous-tip predominant pattern of intraepithelial lymphocyte distribution, with the loss of the 'decrescendo' pattern, 14,26 has been used to suggest the diagnosis of celiac disease in such cases (as well as in biopsies with only mild intraepithelial lymphocytosis).…”

Section: Discussionmentioning

confidence: 99%

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

et al. 2005

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We have observed expansions of intraepithelial lymphocytes in duodenal biopsies from patients with Helicobacter pylori gastritis. This study was undertaken to prospectively evaluate, unselected, paired gastric and duodenal biopsies from 50 patients with H. pylori gastritis and a comparison group of 30 patients with other types of gastritis (10 autoimmune and 20 reactive) to: (1) quantify duodenal intraepithelial lymphocytes, determine their distribution patterns, epithelial location, and phenotype, and (2) correlate the intraepithelial lymphocyte elevations with various features of gastric and duodenal pathology. Intraepithelial lymphocytes were analyzed with antibodies including CD3, CD8, and TIA-1. A stain for H. pylori was performed on all gastric and duodenal biopsies. Duodenal intraepithelial lymphocytes from patients with H. pylori gastritis (using CD3) ranged from 3 to 42 lymphocytes/100 epithelial cells (mean 18.5) compared to 3 to 18 lymphocytes/100 epithelial cells (mean 6.6) in the comparison group. Intraepithelial lymphocyte elevations were seen in 44% of the duodenal biopsies from patients with H. pylori gastritis (using CD3). Significant differences in the intraepithelial lymphocyte counts between patients with H. pylori gastritis and the comparison group were seen for all three T-cell antigens (Po0.001 for CD3 and CD8 and Po0.002 for TIA-1). Duodenal intraepithelial lymphocytes in the H. pylori þ cases had a latent cytotoxic phenotype, H. pylori was not visualized in any of the duodenal biopsies from patients with H. pylori gastritis, and no patient had clinical evidence of celiac disease. Our study highlights frequent duodenal intraepithelial lymphocytosis in individuals with H. pylori gastritis and the lymphocyte distribution patterns (and numbers) overlapped with those described for celiac disease patients. H. pylori gastritis must be considered as a possible explanation for duodenal intraepithelial lymphocytosis with normal villous architecture, especially when lymphocytosis is patchy, intraepithelial lymphocytes display a 'latent' cytotoxic phenotype, and the clinical findings and serologic profile does not fit celiac disease.

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Section: Discussionmentioning

confidence: 99%

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

et al. 2005

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“…Indeed, endoscopic imaging has been applied to numerous studies of coeliac disease, which exhibits similar but more extreme changes in intestinal structure to EED, including scalloped duodenal folds, grooves, fissurations and loss of the finger-shaped villi that cover the healthy mucosal surface 23 . The contrast of the villous structure can be enhanced through techniques including water immersion 24 , high-definition (HD) endoscopy 25 , chromoendoscopy 26 , narrow band imaging (NBI) 27 , and other forms of optical or digital chromoendoscopy such as optimal band imaging (OBI) 28 , providing sensitivities and specificities of up to 100% for villous atrophy 25 . FIGURE 2a-d shows the contrast improvement offered by optical chromoendoscopy, revealing clear differences between healthy and unhealthy villous mucosa.…”

Section: Biomarkers For Eedmentioning

confidence: 99%

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Thompson

Hughes

Anastasova

et al. 2017

Nat Rev Gastroenterol Hepatol

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| Environmental enteric dysfunction (EED) is a disease of the small intestine affecting children and adults in low and middle income countries. Arising as a consequence of repeated infections, gut inflammation results in impaired intestinal absorptive and barrier function, leading to poor nutrient uptake and ultimately to stunting and other developmental limitations. Progress towards new biomarkers and interventions for EED is hampered by the practical and ethical difficulties of cross-validation with the gold standard of biopsy and histology. Optical biopsy techniques -which can provide minimally invasive or noninvasive alternatives to biopsy -could offer other routes to validation and could potentially be used as point-of-care tests among the general population. This Consensus Statement identifies and reviews the most promising candidate optical biopsy technologies for applications in EED, critically assesses them against criteria identified for successful deployment in developing world settings, and proposes further lines of enquiry. Importantly, many of the techniques discussed could also be adapted to monitor the impaired intestinal barrier in other settings such as IBD, autoimmune enteropathies, coeliac disease, graft-versus-host disease, small intestinal transplantation or critical care. Members of the board and experts met to discuss the horizon scan in London, UK, in November 2015 and San Francisco, USA, in February 2016. Literature searches were performed using Web of Science, as well as through the advice of the advisory board and experts. The results of the horizon scan are presented in this Consensus Statement, which entails a review of EED, a discussion of technologies deemed relevant to EED (based on literature searches and the opinions of the advisory board and experts), and a series of recommendations for the future application of the rele vant technologies to the study and diagnosis of EED. In the Recommendations section, each technology has been assessed according to its suitability for application to EED and this assessment includes an evaluation of the cost, invasiveness and appropriateness for developing countries of each device and/or technique. This assessment was performed in a qualitative manner based on currently available information (for example, the present cost and size of the devices) and the opinions of the authors as to feasible future develop ment. Technique suitability for use in developing countries was determined in a qualitative manner after consideration of the need for advanced infrastructure and high levels of training for either system use or data analysis. Probable deployment time scales have also been assigned to each technique based on the current states of development and the degree of valid ation work that will be required before application to EED. These timescales have been tentatively defined as short-term (suitable for deployment immediately or within ~1 year), mediumterm (suit able for deployment within ~1-3 years) and long-term (suitable for deployme...

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“…A number of recently developed techniques have been found useful to enhance the endoscopic images of villous atrophy, including magnification endoscopy [10], with or without chromoendoscopy [11], immersion techniques [12], and confocal endoscopy [13][14][15][16]. However, some of these methods typically require sophisticated instrumentation, special training, and expertise.…”

Section: Enhancement Of Endoscopic Images By I-scan and Other Meansmentioning

confidence: 99%

Detection of Villous Atrophy Using Endoscopic Images for the Diagnosis of Celiac Disease

2013

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Combined magnification endoscopy with chromoendoscopy in the evaluation of patients with suspected malabsorption

Cited by 107 publications

References 10 publications

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

Duodenal intraepithelial lymphocytosis with normal villous architecture: common occurrence in H. pylori gastritis

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Detection of Villous Atrophy Using Endoscopic Images for the Diagnosis of Celiac Disease

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