Endoscopic evaluation of celiac disease severity and its correlation with histopathological aspects of the duodenal mucosa

Abstract

Background and study aims: Celiac disease (CD) is a chronic systemic autoimmune disorder affecting genetically predisposed individuals, triggered and maintained by the ingestion of gluten. Triggered and maintained by the ingestion of gluten, celiac disease is a chronic systemic autoimmune disorder affecting genetically predisposed individuals. Persistent related inflammation of the duodenal mucosa causes atrophy architecture detectable on esophagogastroduodenoscopy (EGD) and histopathology. We investigated the association between endoscopic features and histopathological findings (Marsh) for duodenal mucosa in celiac disease patients and propose an endoscopic classification of severity. Patients and methods: Between January 2000 and March 2010, an electronic database containing 34,540 EDGs of patients aged > 14 years was searched for cases of CD. Out of 109 cases, 85 met the inclusion criteria: conventional EGD combined with chromoendoscopy, zoom and biopsy. EGD types 0, I and II corresponds to Marsh grades 0, 1 and 2, respectively, while EGD type III corresponds to Marsh grade 3 and 4. Results: Five patients (5.8 %) were EGD I but not Marsh grade 1; 25 patients (29.4 %) were EGD II, 4 of whom (16 %) were classified as Marsh grade 2; and 55 patients (64.7 %) were EGD III, 51 (92.7 %) of whom were classified as Marsh grades 3 and 4. The Spearman correlation coefficient (r = 0.33) revealed a significant association between the methods (P = 0.002). Conclusions: Changes in the duodenal mucosa detected on EGD were significantly and positively associated with histopathologic findings. The use of chromoendoscopy in addition to conventional EGD enhances changes in the duodenal mucosa and permits diagnosis of CD, even in routine examinations. The proposed endoscopic classification is practical and easily reproducible and provides valuable information regarding disease extension.

Correlation between histopathological and endoscopic findings of non-malignant gastrointestinal lesions: an experience of a tertiary care teaching hospital from Northern India

“…This is in contrast by observations made by Bonatto MW et al and Dickey W who had concluded in their studies that the changes in the duodenal mucosa were significantly and positively associated with histopathologic findings. 18,19 Our findings are similar to those conducted by Kazi JI et al 14 who have also concluded similar results as in the present study of poor predictive value of endoscopy alone in comparison to histopathological examination.…”

Role of endoscopy in the diagnosis of coeliac disease: a narrative review

“…The authors showed that this classification increased the agreement between endoscopy and histopathology. However, the agreement remained weak in less severe cases ( 38 ).…”

Maladie cœliaque de l’adulte révélée par une polysérite

“…Notre patient présente une forme de MC sèche sans troubles du transit et le diagnostic a été porté sur la fibroscopie digestive haute. Les avancées dans les méthodes de diagnostics et de dépistage ont contribué à une augmentation apparente de l’incidence des MC puisque plus de 80 % des cas diagnostiqués sont asymptomatiques ou pauci symptomatiques [ 4 ]. Sa sérologie était négative et on estime qu’elle n’est utile que dans 58%; 44,8% et 36,8% respectivement pour les anticorps anti gliadine de type A, les anti endomysium et les anti transglutaminases [ 5 ].…”