Routine Duodenal Biopsies in the Absence of Endoscopic Markers of Celiac Disease Are Not Useful: An Observational Study

Abstract

Background. European studies have shown the utility of limiting endoscopic biopsies to diagnose celiac disease (CD) to patients that have high-risk symptoms or present with positive serology. However, many centers in the U.S. have open access endoscopy. Patients are referred without prior serologic testing, and endoscopists often decide whether or not to biopsy at the time of procedure. Aims. Evaluate the yield of duodenal biopsies for the diagnosis of CD in patients undergoing upper endoscopy without prior serologic testing. Methods. This retrospective study evaluated the frequency of CD diagnosis based duodenal biopsies. Researchers were interested in the yield of endoscopic stigmata findings in patients with high-risk symptoms versus low risk. Results. Eight hundred and ten patients met entry criteria at the Cleveland Clinic Florida between 2004 and 2008; 320 presented with highrisk symptoms; and 490 low risk. Sixty-one (7.5%) displayed endoscopic stigmata, and 10/61 (16.3%) were diagnosed with CD. Only patients who exhibited endoscopic stigmata were later diagnosed based on histologic findings. The presence of endoscopic stigmata greatly increased the probability of diagnosing CD, with a positive likelihood ratio of 15.6. Conclusions. When performing upper endoscopy without known serological markers for CD, clinicians should limit duodenal biopsies to patients with high-risk symptoms or endoscopic stigmata.

Histomorphological study of duodenum with special reference to RUT (Rapid Urease Test) negative dyspepsia in a rural care setting

“…Earlier studies by Balasubramanian P et al (14) reported normal villi architecture in 40.6% cases. Endoscopic duodenal nodularity was found in 16.6% cases in our study which are quite similar to study conducted by Castro F et al [16].…”

“…(14) Major histopathological features of untreated celiac disease in duodenal biopsies are intraepithelial lymphocytosis, increased number of inflammatory cells at lamina propria and villous atrophy [15]. Howeverdiagnostic yield of routine duodenal biopsy for celiac disease was low as reported by Castro F et al, Stoven SA et al [8,16].…”

Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre

“…Previous studies have demonstrated the poor diagnostic yield (0.4–1.6%) of routine SBBx in the evaluation of anemia without positive serological tests or other strong indications . These studies have established the need for biopsies in only those with “high‐risk” features but have not categorized anemia into IDA versus non‐IDA, a group in which the incidence of celiac disease is low.…”

“…Consequently, routine duodenal or small bowel mucosal biopsies (SBBx) are recommended for patients presenting with anemia. However, previous studies have demonstrated the poor diagnostic yield of routine SBBx, at a significant cost to the health‐care system . Whilst SBBx is generally safe, clinically significant bleeding requiring blood transfusion can occur in 0.004–0.14%, and there are case reports of SBBx‐associated perforation …”

Celiac Disease and Nonceliac Gluten Sensitivity

“…Careful examination of the duodenum is needed to detect endoscopic markers of villous atrophy, which should trigger the endoscopist to do biopsies. As shown by Castro et al, detection of endoscopic markers is associated with a high probability of diagnosing celiac disease (15.6 positive likelihood ratio) [87], so they should be attentively searched for, especially in high-risk patients.…”