Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy

Saverymuttu, S. H.; Sabbat, Jan; Burke, M.; Maxwell, James

doi:10.1136/pgmj.67.783.47

Cited by 24 publications

(8 citation statements)

References 3 publications

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“…These findings almost certainly reflect an increased awareness of coeliac disease in recent years and the greater use offibre optic endoscopes to obtain small intestinal biopsy specimens. 6 Swinson et al' showed a bimodal distribution with a peak in the fourth decade mainly of women and a later peak in the sixth and seventh decades consisting mainly of men. The ratio of male to female new members of the Coeliac Society also suggests a tendency towards later diagnosis in men with a ratio of 1:2-9 in patients presenting before the age of 60 years, compared with 1:1 2 in those presenting over this age.…”

Section: Discussionmentioning

confidence: 98%

Coeliac disease in the elderly.

Hankey

Holmes

1994

Gut

140

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Of 228 patients with adult coeliac disease, 42 (19%) were diagnosed aged 60 years or over. In this series, of 35 patients who did not have dermatitis herpetiformis, 15 had attended family doctors and hospital outpatient departments for an average of 28 years with unexplained symptoms or abnormalities in blood tests but the diagnosis of coeliac disease had been missed. This is unsatisfactory because these patients can both manage and respond to a gluten free diet. Thirty eight patients complied strictly with the diet with resolution of symptoms. Significant improvement in weight, haemoglobin, albumin, calcium, and alkaline phosphatase values after a year on the diet also occurred. Clinicians should be alert to the possibility of coeliac disease in the elderly particularly in patients with non-specific complaints in the presence of unexplained anaemia. (Gut 1994; 35: 65-67) diagnosis by biopsy was made in 1958. Forty two patients from this group were diagnosed in their seventh decade and beyond and form the basis of this study. These cases were diagnosed between 1963 and 1991 but 35 were diagnosed in 1980 or later.All but three of the 42 patients were regularly reviewed in the coeliac clinic, which was established in 1978

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Section: Discussionmentioning

confidence: 98%

Coeliac disease in the elderly.

Hankey

Holmes

1994

Gut

140

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“…The apparently higher prevalence of coeliac disease is partly due to improved diagnostic methods. It is no longer necessary to use a Crosby capsule to obtain a jejunal biopsy, the same information being much easier to obtain with endoscopic biopsies of the duodenum (19–21). Also, the recent availability of simple blood tests that can conveniently screen for the condition makes it much easier for the disease to be picked up in the primary care setting (22–26).…”

mentioning

confidence: 99%

Pathological and clinical significance of increased intraepithelial lymphocytes (IELs) in small bowel mucosa

Chang

Mahadeva

Deere

2005

APMIS

118

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Intestinal intraepithelial lymphocytes (IELs) belong to a unique T-cell population interspersed between epithelial cells of both the small and large intestine. It is becoming increasingly recognised that an increased number of IELs with a normal villous architecture is within the wide spectrum of histological abnormalities observed in coeliac disease. An increased number of IELs is the earliest pathological change following gluten challenge and a high IEL count may be the only sign of gluten sensitivity. Therefore, the finding of a raised IEL count with normal villous architecture is of sufficient clinical importance to be reported in routine small bowel biopsies. However, it is evident that not all small intestinal biopsy specimens showing increased IELs are explained by gluten sensitivity. Increased IELs in small bowel mucosa have also been associated with autoimmune disorders, tropical sprue, food protein intolerance, Helicobacter pylori-associated gastritis, peptic duodenitis, parasitic and viral infections, as well as the development of intestinal lymphoma. Histological examination of a biopsy specimen of the small bowel remains the diagnostic gold standard for coeliac disease. There will be an ever increasing demand for histological confirmation of gluten sensitivity in patients in whom the classic microscopic appearance of flattened villi may not have fully developed. The more widespread recognition by histopathologists of the pattern of injury manifested by increased numbers of IELs in intestinal biopsy specimens will certainly help in early diagnosis of coeliac disease, lessen diagnostic confusion and influence the modern practice of gastrointestinal tract medicine. This review discusses some of the recent developments in clinical pathology pertaining to increased IELs in small bowel mucosal biopsies.

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“…Необходимость выполнения биопсии тонкой кишки для диагности ки заболевания была утверждена экспертным кон сенсусом [50,51]. Проведение эндоскопической био псии тонкой кишки существенно повышает по казатель выявляемости целиакии [52] и является «золотым стандартом» диагностики заболевания [53]. Для проведения адекватной диагностики цели акии должны быть получены по 4-6 образцов био птатов из нескольких зон дистального отдела две надцатиперстной кишки, обычно на уровне ампулы большого дуоденального сосочка (papilla Vateri).…”

Section: диагностикаunclassified

Celiac disease. From the pathogenesis to the treatment

Farber¹,

Никонов²

2014

Dok. gastroenterol.

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В работе рассмотрены клинические проявления, лабораторные и инструментальные методы исследования, использующиеся при диагностике целиакии. Указаны клинические проявления и клинико-морфологические особенности заболевания, варианты его течения, а также диетологические ограничения и лечение. This article is focused on the clinical manifestations of celiac disease, the laboratory and instrumental methods used for the study and diagnostics of this pathological condition. The main clinical symptoms as well as specific clinico-morphological features of this pathology are described. Variants of its clinical picture are considered with special reference to the relevant therapeutic modalities and dietary restrictions.

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Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy

Cited by 24 publications

References 3 publications

Coeliac disease in the elderly.

Coeliac disease in the elderly.

Pathological and clinical significance of increased intraepithelial lymphocytes (IELs) in small bowel mucosa

Celiac disease. From the pathogenesis to the treatment

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