Rates of Duodenal Biopsy During Upper Endoscopy Differ Widely Between Providers

Pitman, Max; Sanders, David S.; Green, Peter H.R.; Lebwohl, Benjamin

doi:10.1097/mcg.0000000000000957

Cited by 9 publications

(5 citation statements)

References 31 publications

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“…19 Patients may even undergo upper endoscopy to evaluate symptoms, but duodenal biopsy samples are not collected and analyzed, because of a normal-appearing duodenum-the endoscopic appearance may be normal, but there is microscopic evidence of villous atrophy. 13,20,21 Prior low estimates of celiac disease, dating to the 1960s (based on diagnosis rates), have led some clinicians to believe that celiac disease is a rare condition. This results in the testing of only patients with characteristics such as chronic diarrhea and a family history of celiac disesae.…”

Section: Diagnosis Ratesmentioning

confidence: 99%

Epidemiology, Presentation, and Diagnosis of Celiac Disease

2021

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The incidence of celiac disease is increasing, partly because of improved recognition of, and testing for, the disease. The rise in incidence is also due to a real increase of this immune-based disorder, independent of disease detection. The reasons for this true rise in recent decades are unknown but may be related to environmental factors that may promote loss of tolerance to dietary gluten. Strategies to reduce the development of celiac disease have not been proven successful in randomized trials, but the quantity of early-life gluten exposure has been a major focus of prevention efforts. The criteria for the diagnosis of celiac disease are changing, but in adults, diagnosis still depends on the presence of duodenal villous atrophy while the patient is on a gluten-containing diet, along with findings from serology analysis. Although guidelines in the United States continue to mandate a biopsy at all ages, some children receive a diagnosis of celiac disease without a biopsy. If proven accurate and scalable, assays that detect gluten-HLA tetramer complexes might be used in diagnosis to be made in the context of a gluten-free diet without intestinal biopsy.

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Section: Diagnosis Ratesmentioning

confidence: 99%

Epidemiology, Presentation, and Diagnosis of Celiac Disease

2021

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“…The pooled diagnostic yield of random duodenal biopsies to assess for celiac sprue-like histologic changes in patients with IDA in the United States was low at 1.15% (95% CI, 0.89%-1.44%). The studies included data from 7993 patients and certainty of evidence was very low due to increased risk of bias (mainly selection bias) and serious imprecision [16][17][18]76,[99][100][101][102][103][104][105] ( Figure 7).…”

Section: What Is the Utility Of Routine Small Bowel Biopsies For Celimentioning

confidence: 99%

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

et al. 2020

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“…In order to increase the diagnostic rate of silent and atypical CD, several strategies have been tackled over the years: raising awareness about the disease and at-risk groups; using point-of-care tests; careful inspection of the duodenum to detect markers of villous atrophy, including bulb biopsy sampling to detect ultrashort CD; increasing adherence to the guideline-recommended biopsy protocol; and improving serologic, endoscopic, and histologic assessment [36][37][38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study

Balaban,

Coman,

Enache

et al. 2023

Gastroenterology Insights

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Introduction: Despite being one of the most frequent chronic digestive diseases worldwide, with a prevalence of 1%, celiac disease (CD) remains severely underdiagnosed. Among the instruments used to improve its diagnostic rate, hematologic parameters have been proposed as screening tests to select patients with an increased probability of having CD. Assessment of coagulation is included in routine check-ups, and CD has been reported to be associated with coagulopathy. We aimed to assess if subtle changes in coagulation tests could be used in clinical practice to prompt testing for CD. Methods: We retrospectively recruited all patients with clinical suspicion for CD during a study period of 7 years (between 2015 and 2022), who were tested using IgA tissue transglutaminase (tTG) serology and serum total IgA (IgG tTG in case of IgA deficiency) and who underwent upper gastrointestinal endoscopy with multiple biopsy sampling of the duodenal bulb and distal duodenum. We stratified patients into three groups: newly diagnosed CD, gluten-free diet-treated CD, and non-CD controls. Results: Altogether, there were 133 CD patients (71 newly diagnosed, 62 GFD-treated) and 57 non-CD controls. Mean age and gender distribution were similar among the three groups: 43.3 years for newly diagnosed CD, 41.6 years for non-CD controls, and 44 years for GFD-treated CD patients, with a male gender distribution of 21.1%, 28%, and 24.1%, respectively. Among the included newly diagnosed CD patients, 14% had a prolonged INR. The mean INR was slightly higher in newly diagnosed CD patients, compared to GFD-treated CD patients and non-CD controls: 1.12 ± 0.30, 1.02 ± 0.83, and 1.00 ± 0.08, respectively (p = 0.009). Consequently, prothrombin activity was slightly lower in newly diagnosed CD patients, compared to GFD-treated CD and non-CD controls: 94.9 ± 19.3%, 102.3 ± 12.8%, and 101.9 ± 15.15, respectively. Interestingly, after GFD, the mean INR and prothrombin activity of CD individuals reached a value similar to that of non-CD controls. Conclusions: Subtle changes in INR, defined as a value within the normal range, but closer to the upper limit, could be an indicator of probability for CD.

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Rates of Duodenal Biopsy During Upper Endoscopy Differ Widely Between Providers

Cited by 9 publications

References 31 publications

Epidemiology, Presentation, and Diagnosis of Celiac Disease

Epidemiology, Presentation, and Diagnosis of Celiac Disease

AGA Technical Review on Gastrointestinal Evaluation of Iron Deficiency Anemia

Prevalence of Coagulopathy in Patients with Celiac Disease: A Single-Center Retrospective Case-Control Study

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