1994
DOI: 10.1136/jcp.47.8.693
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Pitfalls in diagnosing coeliac disease.

Abstract: Aims-To highlight the pitfalls in the diagnosis of coeliac disease and to make recommendations for its diagnosis and the management of refractory cases with equivocal histology. Methods-Six patients, referred since 1989 with a diagnosis of coeliac disease based on duodenal biopsy specimens taken at endoscopy, and who failed to respond to a gluten-free diet were studied. All patients were subjected to peroral jejunal biopsy. Morphometric analysis of villus height:crypt depth ratios, surface enterocyte cell heig… Show more

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Cited by 66 publications
(34 citation statements)
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“…This has been adequately pointed out by Shidrawi et al [13]. They presented their experience with 5 adult patients diagnosed inappropriately as having CD in poorly sampled and tangentially sectioned biopsies.…”
mentioning
confidence: 88%
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“…This has been adequately pointed out by Shidrawi et al [13]. They presented their experience with 5 adult patients diagnosed inappropriately as having CD in poorly sampled and tangentially sectioned biopsies.…”
mentioning
confidence: 88%
“…This background may be an explanation for the so-called patchy lesions [14,15], a condition that we have never been able to record, and even for the reports of alleged normal-appearing first biopsy in later grade 3 and 4 atrophy biopsies in children with CD [16]. Adequate sampling (distal duodenum, proximal jejunum) is also to be underlined [13].…”
mentioning
confidence: 99%
“…76 It is unclear whether attempts at orientation of the small biopsies taken at endoscopy, prior to fixation, could alleviate this problem. Another problem arises when biopsies in patients with a high likelihood of celiac disease, and positive serologies, are reportedly normal.…”
Section: Biopsy and Histologymentioning
confidence: 99%
“…Another important step is to review the initial biopsy material to ensure that the patient does in fact have celiac disease. Inadequate biopsy material and misinterpretation of poorly oriented biopsies may lead to overinterpretation of villous atrophy by pathologists who are unfamiliar with the interpretation of duodenal biopsies [7].…”
Section: Response To the Gluten-free Dietmentioning
confidence: 99%