Prediction of celiac disease at endoscopy

Barada, Kassem; Habib, Robert H.; Malli, Ahmad; Hashash, Jana G.; Halawi, Houssam; Maasri, Karim; Tawil, Ayman; Mourad, Fadi H.; Sharara, Ala I.; Soweid, Assaad; Sukkarieh, Ismail; Chakhachiro, Zaher; Jabbour, Mark N.; Fasano, Alessio; Santora, Debbie; Arguelles, Carolina; Murray, Joseph A.; Green, Peter H.

doi:10.1055/s-0033-1359200

Cited by 41 publications

(34 citation statements)

References 37 publications

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“…Endoscopy with histological assessment of villous atrophy of the duodenum still represents the gold standard for diagnosis of celiac disease. However, WLE with random biopsies in the duodenum has not been shown to have great accuracy in the diagnosis of celiac disease [10,13]. Our study has shown a poorer correlation between WLE grade and Marsh histologic grade in the diagnosis of celiac disease (r = 0.31; P = 0.01) compared with the i-SCAN-HDWI endoscopic technique.…”

contrasting

confidence: 55%

“…Our study has shown a poorer correlation between WLE grade and Marsh histologic grade in the diagnosis of celiac disease (r = 0.31; P = 0.01) compared with the i-SCAN-HDWI endoscopic technique. In addition, a more recent paper by Barada et al has indicated that standard endoscopic findings were related to a significant rate of underdiagnosis of celiac disease [13]. Novel emerging endoscopic techniques such as water immersion techniques, chromoendoscopy, and optical digital enhancement virtual chromoendoscopy have been developed to better characterize in detail the vascular and surface architecture of the gastrointestinal tract.…”

mentioning

confidence: 99%

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964 High Definition iSCAN Endoscopy With Water Immersion Technique Accurately Reflects Histological Severity of Celiac Disease

Gui¹,

Love²,

Ghosh³

et al. 2013

Gastroenterology

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contrasting

confidence: 55%

mentioning

confidence: 99%

964 High Definition iSCAN Endoscopy With Water Immersion Technique Accurately Reflects Histological Severity of Celiac Disease

Gui¹,

Love²,

Ghosh³

et al. 2013

Gastroenterology

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“…Our hospital laboratory reports a combined tTG IgA/IgG result. Positive tTG serology was defined as a level of 30 U/mL or above . HLA genotyping was performed using an Affymetrix Kaiser Axiom array to locate single nucleotide polymorphisms (SNPs) on chromosome 6.…”

Section: Susceptibility For Celiac Disease Based On Tissue Transglutamentioning

confidence: 99%

Luminal Clinical

2017

J of Gastro and Hepatol

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Background: Dysregulation of the zonulin pathway has been linked to a "leaky gut" due to zonulin's putative role as a modulator of intestinal epithelial tight junctions. Zonulin is a proposed contributor to the pathogenesis of non-celiac gluten sensitivity/irritable bowel syndrome (NCGS), celiac disease (CD), and inflammatory bowel disease (IBD). However, controversy lies in zonulin's utility as a serum biomarker of disease and in the assays used for its assessment. Aims: To characterize serum zonulin levels among individuals with gastrointestinal conditions (NCGS, CD, and IBD) and healthy individuals and to verify existing commercially available assays for zonulin quantification. Methods: Serum zonulin was measured in patients with self-reported NCGS (n = 36), CD (n = 37), and IBD (n = 20), as well as healthy participants (n = 49) by ELISA (CUSABIO). Zonulin non-producers were determined by western blot-based haptoglobin phenotyping. The commercial assay was spiked with recombinant zonulin for verification. Zonulin levels in selected sera were compared with those determined by another commercially available assay (Immundiagnostik). Results: Overall, 33 of 36 patients with NCGS, 34 of 37 with untreated CD, 19 of 20 with IBD, and 46 of 49 healthy participants were zonulin producers. Compared with healthy individuals (median, 0.00 ng/mL; interquartile range [IQR], 0.00 ng/mL), patients with NCGS (median, 0.25 ng/mL; IQR, 0.88 ng/mL), CD (median, 0.07 ng/mL; IQR, 1.27 ng/mL), and IBD (median, 1.73 ng/mL; IQR, 2.02 ng/mL; all P < 0.0001) had elevated serum zonulin levels ( Figure 1). Levels in IBD were higher than those in NCGS (P = 0.001) and CD (P = 0.002), with no differences between NCGS and CD.However, recombinant zonulin protein was not detected by the assay. In addition, two of 19 participants who were zonulin non-producers had levels of the protein detected by the assay. There was poor correlation between the results of the two commercially available assays (for levels expressed in ng/mL, n = 29; r = 0.24; P = 0.22). Conclusion: Serum zonulin levels are elevated in patients with NCGS, CD, and IBD, with the highest levels in IBD when tested using a previously applied commercial ELISA. However, recombinant zonulin protein was not detected by this assay, zonulin non-producers had zonulin detected, and there was no concordance with the results from an alternative assay. Rather than support a role for zonulin in intestinal disease pathogenesis, these results cast doubt on the validity of commercially available zonulin assays.Unexpectedly high rates of significant findings at capsule endoscopy in young women with suspected small intestinal bleeding: Don't be ageist S ALUKAIDEY,* R KNIGHT, † L BESWICK,* , † C HAIR* , † *University Hospital Geelong, Geelong, † Deakin University, School of Medicine, Melbourne, Victoria, AustraliaBackground: Capsule endoscopy (CE) is widely used in female patients who present with suspected recurrent small intestine bleeding. However, the yield from CE in young women (aged < 50 years)...

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“…1). Although these endoscopic markers, when identified during conventional EGD, have shown good specificity (about 95-100%) for the diagnosis of CD, they are lacking in sensitivity (50-80%) [9,10,11]. However, these figures refer to endoscopic markers identified by conventional EGD.…”

Section: Diagnosis Of Suspected CDmentioning

confidence: 99%

Videocapsule Endoscopy in Celiac Disease: Indications and Timing

Rondonotti¹,

Paggi²

2015

Dig Dis

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Background: Because of its technical characteristics (i.e. 8-fold magnification, capability to inspect the entire small bowel) and minimal invasiveness, videocapsule endoscopy (VCE) has been proposed as a useful tool for managing patients with celiac disease (CD). Key Messages: Although VCE has been found to be highly sensitive and specific in identifying CD endoscopic markers, it is still inadequate to replace esophagogastroduodenoscopy (EGD) with biopsies in the diagnosis of CD. Nevertheless, it represents a reliable alternative in patients unable or unwilling to undergo EGD. Up to now, available studies have failed to identify any correlation between the length of small bowel involvement and the severity of symptoms. The available evidence on the use of VCE in diagnosing CD in equivocal cases (patients with positive serology and negative or nonspecific histology or those with negative serology and histologically proven villous atrophy) is limited, and its role is still under discussion. In CD patients not improving on gluten-free diet, a complete workup is necessary. In patients with nonresponsive (NRCD) or refractory CD (RCD), VCE has been shown to be able not only to detect significant findings, driving further management, but also to rule out major complications. Nevertheless, in this setting, the inability of VCE to take tissue samples and the risk of capsule retention can represent major limitations. Conclusions: At the present time, for diagnostic purposes, VCE can be proposed only in patients unable or unwilling to undergo EGD, whereas it could be useful in some equivocal cases. Conversely, there is no room for VCE either to estimate the length of the small bowel affected by villous atrophy or to follow up patients improving on gluten-free diet. In patients with NRCD or RCD, VCE can play a role, but it should be combined with other diagnostic techniques.

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Prediction of celiac disease at endoscopy

Cited by 41 publications

References 37 publications

964 High Definition iSCAN Endoscopy With Water Immersion Technique Accurately Reflects Histological Severity of Celiac Disease

964 High Definition iSCAN Endoscopy With Water Immersion Technique Accurately Reflects Histological Severity of Celiac Disease

Luminal Clinical

Videocapsule Endoscopy in Celiac Disease: Indications and Timing

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