Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers

Abstract

Background: Small intestinal biopsy with villous atrophy (VA) is the gold standard for the diagnosis of celiac disease (CD). We validated VA (Marsh 3) and small intestinal inflammation without VA (Marsh 1+2) in Swedish regional biopsy registers.

Risk of tuberculosis in a large sample of patients with coeliac disease - a nationwide cohort study

“…Biopsy reports have a high sensitivity for diagnosed CD. 15 In a questionnaire study 15 96% of Swedish adult gastroenterologists and 100% of paediatric gastroenterologists reported performing small intestinal biopsy before CD diagnosis in at least 9 out of 10 patients. On average, three biopsies are taken, 16 which is likely to rule in about 95% of patients with CD.…”

“…We collected data from duodenal ⁄ jejunal biopsy reports with VA (Marsh stage 3 and equal to CD) 15 16 More information on that data collection has been published in two validation papers. 15,16 When examining TB in patients with CD, we used the same dataset as in our paper on overall mortality in CD.…”

“…15,16 When examining TB in patients with CD, we used the same dataset as in our paper on overall mortality in CD. 17 This dataset consisted of 29 096 individuals with CD.…”

“…19 We also reviewed patient charts and laboratory data in 114 randomly selected patients in our cohort and concluded that 108 (95%) of those with VA had CD. 15 Furthermore, we reviewed a large number of biopsy reports (through computerised searches followed by manual review). This review found that diagnoses other than CD were very uncommon in individuals with VA (any inflammatory bowel disease, 0.3%; Helicobacter pylori, 0.2% and gastric metaplasia, 0.1%).…”

Diagnostic challenges in celiac disease

“…2,12 Tangential sectioning and insufficient size of samples may lead to misinterpretation and overdiagnosis of VA. 26 Although CD is the most common cause of villous atrophy, there are many other conditions with similar histopathology. 27 Therefore, in the absence of positive serology, this condition, defined as seronegative villous atrophy (SVA), should be further investigated. Performing HLA DQ2/DQ8 typing in the first step can exclude CD in case of negative result.…”